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ASSOCIATION OF BLOOD GLUCOSE AND HEMOGLOBIN A1C LEVEL WITH SURGICAL OUTCOMES: SHOULD GLYCEMIC CONTROL BE MODIFIED?
1981 JACC March 21, 2017 Volume 69, Issue 11
Valvular Heart Disease ASSOCIATION OF BLOOD GLUCOSE AND HEMOGLOBIN A1C LEVEL WITH SURGICAL OUTCOMES: SHOULD GLYCEMIC CONTROL BE MODIFIED? Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Changing the Natural History of Valve Disease With Medical Therapy Abstract Category: 37. Valvular Heart Disease: Therapy Presentation Number: 1185-031 Authors: Niv Ad, Sari Holmes, Stephen Clement, Cardiac Vascular & Thoracic Surgery Associates, Falls Church, VA, USA
Background: Glycemic control is an integral part of patient care after cardiac surgery, but not all patients may need the same degree of control. We examined whether the effect of blood glucose (BG) on outcomes after cardiac surgery is influenced by preoperative hemoglobin A1c (HgbA1c).
Methods: Data were available for 3808 cardiac surgery patients. BG was examined for the first 72 h after surgery (mean readings = 39). Using clinical criteria, three HgbA1c groups were created: <5.5% (n=1217), 5.5-6.5% (n=1744), and ≥6.5% (n=847). Multivariate analyses examined the effects of HgbA1c and mean BG on outcomes.
Results: No difference found among HgbA1c groups in intraoperative (P=0.95) or postoperative (P=0.23) transfusions. Higher HgbA1c correlated with higher mean BG (P<0.001), maximum BG (P<0.001), and BG variability (P<0.001) after surgery. The effect of any BG value >180 mg/dL on STS-defined outcomes was more prevalent in lower HgbA1c groups (TABLE). A significant interaction of HgbA1c and BG on pneumonia was found (P=0.039; FIGURE). If HgbA1c=4.5%, 10-point increase in mean BG had 38% greater odds for pneumonia, but if HgbA1c=6.5%, 10-point increase in mean BG had only 19% greater odds for pneumonia. Conclusions: Elevated BG was a risk factor for postoperative pneumonia in nondiabetic patients. Risk for pneumonia increased with glycemia in a dose-dependent fashion and was attenuated with HgbA1c >6.5%, suggesting patients with diabetes were protected from adverse impact of postoperative hyperglycemia.
Valvular Heart Disease ASSOCIATION OF BLOOD GLUCOSE AND HEMOGLOBIN A1C LEVEL WITH SURGICAL OUTCOMES: SHOULD GLYCEMIC CONTROL BE MODIFIED? Poster Contributions Poster Hall, Hall C Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m. Session Title: Changing the Natural History of Valve Disease With Medical Therapy Abstract Category: 37. Valvular Heart Disease: Therapy Presentation Number: 1185-031 Authors: Niv Ad, Sari Holmes, Stephen Clement, Cardiac Vascular & Thoracic Surgery Associates, Falls Church, VA, USA
Background: Glycemic control is an integral part of patient care after cardiac surgery, but not all patients may need the same degree of control. We examined whether the effect of blood glucose (BG) on outcomes after cardiac surgery is influenced by preoperative hemoglobin A1c (HgbA1c).
Methods: Data were available for 3808 cardiac surgery patients. BG was examined for the first 72 h after surgery (mean readings = 39). Using clinical criteria, three HgbA1c groups were created: <5.5% (n=1217), 5.5-6.5% (n=1744), and ≥6.5% (n=847). Multivariate analyses examined the effects of HgbA1c and mean BG on outcomes.
Results: No difference found among HgbA1c groups in intraoperative (P=0.95) or postoperative (P=0.23) transfusions. Higher HgbA1c correlated with higher mean BG (P<0.001), maximum BG (P<0.001), and BG variability (P<0.001) after surgery. The effect of any BG value >180 mg/dL on STS-defined outcomes was more prevalent in lower HgbA1c groups (TABLE). A significant interaction of HgbA1c and BG on pneumonia was found (P=0.039; FIGURE). If HgbA1c=4.5%, 10-point increase in mean BG had 38% greater odds for pneumonia, but if HgbA1c=6.5%, 10-point increase in mean BG had only 19% greater odds for pneumonia. Conclusions: Elevated BG was a risk factor for postoperative pneumonia in nondiabetic patients. Risk for pneumonia increased with glycemia in a dose-dependent fashion and was attenuated with HgbA1c >6.5%, suggesting patients with diabetes were protected from adverse impact of postoperative hyperglycemia.