Introduction
Stress hyperglycaemia is common following cardiac surgery. Its optimal management
is uncertain and emerging literature suggests that flexible glycaemic control in diabetic
patients may be preferable. This study aims to assess the relationship between maximal
postoperative in-hospital blood glucose levels (BSL) and the morbidity and mortality
outcomes of diabetic and non-diabetic cardiac surgery patients.
Methods
A retrospective cohort analysis of all patients undergoing cardiac surgery at a tertiary
single centre institution from 2015 to 2019 was undertaken. Early management and outcomes
of hyperglycaemia following cardiac surgery were assessed via multivariable regression
modelling. Follow-up was assessed to 1 year postoperatively.
Results
Consecutive non-diabetic patients (n=1,050) and diabetic patients (n=689) post cardiac
surgery were included. Diabetics with peak BSL ≤13.9 mmol/L did not have an increased
risk of morbidity or mortality compared to non-diabetics with peak BSL ≤10.0 mmol/L.
In non-diabetics, stress hyperglycaemia with peak BSL >10.0 mmol/L was associated
with overall wound complications (5.7% vs 8.8%, OR 1.64 [1.00–2.69], p=0.049) and
postoperative pneumonia (2.7% vs 7.3%, OR 2.35 [1.26–4.38], p=0.007). Diabetic patients
with postoperative peak BSL >13.9 mmol/L were at an increased risk of overall wound
complication (7.4% vs 14.8%, OR 2.47 [1.46–4.16], p<0.001), graft harvest site infection
(3.7% vs 11.8%, OR 3.75 [1.92–7.30], p<0.001), and wound-related readmission (3.1%
vs 8.8%, OR 3.11 [1.49–6.47], p=0.002) when compared to diabetics with peak BSL ≤13.9
mmol/L.
Conclusion
In non-diabetics, stress hyperglycaemia with peak BSL >10.0 mmol/L is associated with
morbidity. In diabetic patients, hyperglycaemia with peak BSL ≤13.9 mmol/L was not
associated with an increased risk of morbidity or mortality compared to non-diabetics
with peak BSL ≤10.0 mmol/L. Further investigation of flexible glycaemic targets (target
BSL ≤13.9 mmol/L) in diabetic patients is warranted.
Keywords
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Article Info
Publication History
Published online: September 22, 2022
Accepted:
August 12,
2022
Received in revised form:
August 2,
2022
Received:
May 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
