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Reduction of Surgical Mortality and Morbidity in Diabetic Patients undergoing Cardiac Surgery with a Combined Intravenous and Subcutaneous Insulin Glucose Management Strategy

¹Division of Endocrinology, Metabolism and Molecular Medicine
²Division of Cardiothoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL

molitch{at}northwestern.edu

ABSTRACT

OBJECTIVE:: To determine if glucose management in post-cardiothoracic (CT) surgery patients with a combined intravenous (IV) and subcutaneous (SC) insulin regimen reduces mortality and morbidity in patients with diabetes and stress-induced hyperglycemia.

RESEARCH DESIGN AND METHODS:: Retrospective review of 614 consecutive patients who underwent CT surgery in 2005 was performed to evaluate the incidence and treatment of postoperative hyperglycemia and operative morbidity and mortality. Hyperglycemic patients (glucose >6.05mmol/L) were treated with IV insulin in the ICU followed by SC insulin (outside ICU). Subgroup analysis was performed on 159 coronary artery bypass graft (CABG) -only patients.

RESULTS:: Among all CT surgeries, patients with a preoperative diagnosis of diabetes had higher rates of postoperative mortality (7.3% vs. 3.3%; p=0.03) and pulmonary complications (19.5%vs. 11.6%; p=0.02), but had similar rates of infections and cardiac, renal and neurologic complications on univariate analysis. However, on multivariate analysis a preoperative diagnosis of diabetes was not a significant factor in postoperative mortality or pulmonary complications. In CABG-only patients, no significant differences were seen in outcomes between diabetic and non-diabetic patients. Independent of diabetic status, glucose 11 mmol/L on ICU admission was predictive of higher rates of mortality and renal, pulmonary, and cardiac postoperative complications.

CONCLUSIONS:: A combination of IV insulin (in the ICU) and SC insulin (outside the ICU), a less costly and less nursing-intensive therapy than 3 days of IV insulin postoperatively, results in a reduction of the increased surgical morbidity and mortality in diabetic patients following cardiothoracic surgery.

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