Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients

Gunjan Y. Gandhi, Gregory A. Nuttall, Martin D. Abel, Charles J. Mullany, Hartzell V Schaff, Brent A. Williams, Lisa M. Schrader, Robert A. Rizza, M. Molly McMahon

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery. PATIENTS AND METHODS: We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (stemal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery. RESULTS: Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P≤.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30% in outcomes (adjusted odds ratio, 1.34; 95% confidence interval, 1.10-1.62). CONCLUSION: Intraoperative hyperglycemic is an independent risk factor for complications, including death, after cardiac surgery.

Original languageEnglish (US)
Pages (from-to)862-866
Number of pages5
JournalMayo Clinic Proceedings
Volume80
Issue number7
StatePublished - 2005

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Hyperglycemia
Thoracic Surgery
Glucose
Pulmonary Ventilation
Delirium
Atrial Fibrillation
Heart Block
Confounding Factors (Epidemiology)
Coma
Heart Arrest
Urinary Tract
Acute Kidney Injury
Tertiary Care Centers
Urinary Tract Infections
Coronary Artery Bypass
Nervous System
Observational Studies
Sepsis
Pneumonia
Diabetes Mellitus

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gandhi, G. Y., Nuttall, G. A., Abel, M. D., Mullany, C. J., Schaff, H. V., Williams, B. A., ... McMahon, M. M. (2005). Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clinic Proceedings, 80(7), 862-866.

Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. / Gandhi, Gunjan Y.; Nuttall, Gregory A.; Abel, Martin D.; Mullany, Charles J.; Schaff, Hartzell V; Williams, Brent A.; Schrader, Lisa M.; Rizza, Robert A.; McMahon, M. Molly.

In: Mayo Clinic Proceedings, Vol. 80, No. 7, 2005, p. 862-866.

Research output: Contribution to journalArticle

Gandhi, GY, Nuttall, GA, Abel, MD, Mullany, CJ, Schaff, HV, Williams, BA, Schrader, LM, Rizza, RA & McMahon, MM 2005, 'Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients', Mayo Clinic Proceedings, vol. 80, no. 7, pp. 862-866.
Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clinic Proceedings. 2005;80(7):862-866.
Gandhi, Gunjan Y. ; Nuttall, Gregory A. ; Abel, Martin D. ; Mullany, Charles J. ; Schaff, Hartzell V ; Williams, Brent A. ; Schrader, Lisa M. ; Rizza, Robert A. ; McMahon, M. Molly. / Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. In: Mayo Clinic Proceedings. 2005 ; Vol. 80, No. 7. pp. 862-866.
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abstract = "OBJECTIVE: To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery. PATIENTS AND METHODS: We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (stemal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery. RESULTS: Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P≤.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30{\%} in outcomes (adjusted odds ratio, 1.34; 95{\%} confidence interval, 1.10-1.62). CONCLUSION: Intraoperative hyperglycemic is an independent risk factor for complications, including death, after cardiac surgery.",
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AU - Gandhi, Gunjan Y.

AU - Nuttall, Gregory A.

AU - Abel, Martin D.

AU - Mullany, Charles J.

AU - Schaff, Hartzell V

AU - Williams, Brent A.

AU - Schrader, Lisa M.

AU - Rizza, Robert A.

AU - McMahon, M. Molly

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N2 - OBJECTIVE: To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery. PATIENTS AND METHODS: We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (stemal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery. RESULTS: Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P≤.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30% in outcomes (adjusted odds ratio, 1.34; 95% confidence interval, 1.10-1.62). CONCLUSION: Intraoperative hyperglycemic is an independent risk factor for complications, including death, after cardiac surgery.

AB - OBJECTIVE: To estimate the magnitude of association between intraoperative hyperglycemia and perioperative outcomes in patients who underwent cardiac surgery. PATIENTS AND METHODS: We conducted a retrospective observational study of consecutive adult patients who underwent cardiac surgery between June 10, 2002, and August 30, 2002, at the Mayo Clinic, a tertiary care center in Rochester, Minn. The primary independent variable was the mean intraoperative glucose concentration. The primary end point was a composite of death and infectious (stemal wound, urinary tract, sepsis), neurologic (stroke, coma, delirium), renal (acute renal failure), cardiac (new-onset atrial fibrillation, heart block, cardiac arrest), and pulmonary (prolonged pulmonary ventilation, pneumonia) complications developing within 30 days after cardiac surgery. RESULTS: Among 409 patients who underwent cardiac surgery, those experiencing a primary end point were more likely to be male and older, have diabetes mellitus, undergo coronary artery bypass grafting, and receive insulin during surgery (P≤.05 for all comparisons). Atrial fibrillation (n=105), prolonged pulmonary ventilation (n=53), delirium (n=22), and urinary tract infection (n=16) were the most common complications. The initial, mean, and maximal intraoperative glucose concentrations were significantly higher in patients experiencing the primary end point (P<.01 for all comparisons). In multivariable analyses, mean and maximal glucose levels remained significantly associated with outcomes after adjusting for potentially confounding variables, including postoperative glucose concentration. Logistic regression analyses indicated that a 20-mg/dL increase in the mean intraoperative glucose level was associated with an increase of more than 30% in outcomes (adjusted odds ratio, 1.34; 95% confidence interval, 1.10-1.62). CONCLUSION: Intraoperative hyperglycemic is an independent risk factor for complications, including death, after cardiac surgery.

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