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| Moderate Control of Hyperglycemia is Superior to Tight Control in Patients Undergoing Coronary Artery Bypass Grafting |
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Castigliano M. Bhamidipati, Damien J. LaPar, John A. Kern, James J. Gangemi, Irving L. Kron, Gorav Ailawadi; Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA Objective: Hyperglycemia has been associated with detrimental outcomes in surgery. Although there has been a consensus in cardiac surgery that tight control of perioperative hyperglycemia (glucose <120mg/dl) is beneficial, recent studies in sepsis have suggested that permissive hyperglycemia may be superior. We sought to determine if tight control or moderate control of hyperglycemia is optimal in patients undergoing coronary artery bypass grafting (CABG). Methods: From 1995-2008, a total of 4658 patients (Primary=4433 [95.17%], Re-operative=225 [4.83%]) with known diabetes or peri-operative hyperglycemia (perioperative serum glucose >126mg/dl and/or preoperative HbA1c ≥8) underwent isolated CABG at our institution. Patients were stratified into three postoperative glycemic control groups: Group I (Tight control, ≤126mg/dl), Group II (Moderate control, 127-179mg/dl), and Group III (Liberal control, ≥180mg/dl). Pre-operative risk factors, glycemic management, and post-operative outcomes were analyzed. Results: Overall operative mortality was 2.5% (119/465) and major complication rate was 12.5% (581/4658). Compared to the tight and liberal glycemic control groups, the moderate control group had the lowest mortality (p=0.016, Table 1). In addition, the moderate control group had a lower incidence of major complications, prolonged ventilation (p<0.001), and postoperative sepsis (I: 3.73% [5/134], II: 0.97% [27/2785], and III: 1.44% [25/1739], p=0.01). Sternal wound infection and stroke were equivalent across the groups (p=0.618 and p=0.6, respectively). More patients in the tight control group had preoperative renal failure (I: 16.42% [22/134], and II: 8.33% [232/2785], p=0.001), and underwent emergent operations (I: 5.22% [7/134], and II: 1.87% [52/2785], p=0.007) compared to the moderate control group. Despite these apparent differences, the STS predicted risk of mortality was lower in the tight compared to the moderate control group (p<0.001). Conclusion: Moderate glycemic control or permissive hyperglycemia is superior to tight glycemic control with decreased mortality and major complications, and may be the ideal strategy in patients undergoing coronary artery bypass operations.  Table 1 Back to 2010 Annual Meeting Back to Program Outline Back to Main Program |
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