Glycemic Optimisation in Cardiothoracic  patients  — ASN Events
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Glycemic Optimisation in Cardiothoracic  patients  (#287)

Tripti Joshi 1 , Sarah Pullen 2 , Alison gebueher 1 , Taranpreet Singh 3 , Shamasunder Acharya 4
  1. John Hunter Hospital, New Lambton, NSW, Australia
  2. Diabetes Services, John Hunter Hospital, New Lambton, NSW , Australia
  3. Department of Surgery, John Hunter Hospital, New Lambton, NSW, Australia
  4. Department of Endocrinology and Diabetes, John Hunter Hopsital, New Lambton, Australia

Introduction: Diabetes is associated with increased morbidity and mortality in patients undergoing cardiac surgery.

Objectives: To investigate if clinical outcomes (HbA1c, blood glucose levels (BGL), hospital mortality, all-cause mortality within 28 days of discharge, readmission rates and length-of-stay (LOS)) improve after implementation of a structured guideline for glycemic management in patients undergoing coronary artery bypass graft (CABG).

Methods: This is a retrospective before-and-after analysis of all consecutive patients admitted for CABG at a tertiary-care university-affiliated hospital. The clinical outcomes during conventional practice of glycemic management ‘before’ implementation of guidelines (July to December 2013) were compared to those ‘after’ implementation (July – December 2014).

Results: Regarding the cohort of CABG patients with diabetes, 48 patients versus 33 patients were enrolled during the before-versus-after phase. The mean HbA1c levels were 7.8% (±1.8) versus 6.8% (±1.4), p=0.024, during the before-versus-after phase. The 95% confidence interval of the mean difference (1%) in HbA1c levels between the two phases was 0.14% to 1.86%. This improvement in glycemic profile persisted for at least 6 months post discharge. The mean BGL was 9.20 (±0.06) mmol/L versus 8.69 (±0.06) mmol/L in the before-versus-after phase. Improvements in hospital mortality [4/48 (8.3%) versus 2/33 (6.1%)], all-cause mortality within 28 days of discharge [1/38 (2.6%) versus 0/24 (0%)], and readmission rates [10/38 (26.3%) versus 4/24 (16.7%)] in the before-versus-after phase were noted. The hospital LOS did not increase with a mean of 14 days for both groups.

Regarding the cohort of CABG patients without diabetes, 86 patients versus 52 patients were enrolled in the before-versus-after phase. The hospital mortality [0/86 (0%)-versus-1/52 (1.9%)], all-cause mortality within 28 days of discharge [0/75 (0%)-versus-0/40 (0%)], and readmission rates [16/75 (21.3%)-versus-9/40 (23.0%)] were similar in the before-versus-after phase. The LOS (mean 11 days versus 15 days), however, worsened in the after phase. Following implementation, diabetic group had less LOS (14 vs.15 days) compared with non-diabetic group.

Conclusions: Within the limits of this small-size study, preliminary analysis shows that timely assessment and effective management of dysglycaemia improves glycemic profiles and clinical outcomes for patients undergoing CABG along with decreasing costs to the health facility.

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