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2007 | 79 | 7 | 496-502

Article title

Influence of Carbohydrate Metabolism Disturbances on Early Postoperative Complications in Patients after Planned Coronary Artery By-pass Graft Surgery

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EN

Abstracts

EN
Improper glucose metabolism unfavorably influences the peri- and postoperative course, considering patients subjected to coronary artery bypass graft surgery. In case of such patients, one can observe an increased amount of perioperative complications.The aim the study was to determine the correlation between carbohydrate metabolism disturbances and mortality, as well as other postoperative complications in patients subjected to coronary artery bypass graft surgery.Material and methods. The study group comprised 117 patients under 80 years of age qualified for coronary artery bypass graft surgery using extracorporeal circulation and Off-Pump Coronary Artery Bypass (OPCAB). Patient observations were undertaken during hospitalization and six weeks after CABG. The examination was of prospective and observational character. The following end-points were considered:1. Cardiological complications:- death connected with cardiac diseases,- cardiogenic shock (low-output syndrome requiring the use of IABP),- pulmonary edema,- myocardial infarction.2. Other complications:- cerebral stroke,- renal insufficiency,- impaired postoperative wound healing following sternotomy or after saphenous veinConsidering statistical analysis, the following patient groups were distinguished: normal glucose metabolism (NGM), impaired glucose metabolism (IGM) or impaired fasting glucose (IFG), previously diagnosed or new diagnosis of diabetes mellitus (DM). The IGT and IFG groups were described as AGM-noDM (abnormal glucose metabolism- no diabetes mellitus).Results. The total number of postoperative complications, considering particular patient groups was as follows: in the NGM group, postoperative complications were noted in 3 (8.8%) patients (p<0.001) vs 9 (23.7%) in the AGM-noDM group (p<0.001) vs 21 (46.7%) in the DM group (p<0.001).The occurrence of particular complications was as follows: cardiogenic shock requiring intra-aortic balloon contrapulsation in 1 (2.9%) patient with NGM vs 1 (2.6%) with AGM-noDM vs 2 (4.4%) with DM. Acute renal insufficiency was observed in 1 (2.9%) patient with NGM vs 3 (7.9%) with AGM-noDM vs 6 (13.3%) with DM. Coronary by-pass graft impatency was noted in 0 patients with NGM vs 0 with AGM-noDM vs 3 (6.7%) patients with DM (p=0.085). Reoperation due to postoperative bleeding was required in 2 (5.9%) patients with NGM vs 4 (10.5%) with AGM-noDM vs 4 (8.9%) with DM. Postoperative cerebral stroke was observed in 0 patients with NGM vs 1 (2.6%) with AGM-noDM vs 2 (4.4%) with DM. Impaired sternotomy wound healing concerned 0 patients with NGM vs 2 (5.9%) with AGM-noDM vs 1 (2.2%) with DM. Impaired saphenous vein wound healing was observed in 0 patients with NGM vs 2 (5.3%) with AGM-noDM vs 23 (51.1%) with DM (p<0.001).Pulmonary edema was observed in 0 patients with NGM vs 1 (2.6%) with AGM-noDM vs 0 with DM. Death did not ocuured in cases of patients with NGM vs 1 (2.6%) with AGM-noDM vs 3 (6.7%) with DM.Conclusions. Postoperative complications occurred more frequently in patients with carbohydrate metabolism disturbances, especially diabetes mellitus, subjected to planned coronary artery bypass graft surgery.

Year

Volume

79

Issue

7

Pages

496-502

Physical description

Dates

published
1 - 7 - 2007
online
27 - 11 - 2007

Contributors

  • Department of Cardiac Surgery, J. Struś Hospital in Poznań
  • Department of Cardiac Surgery, J. Struś Hospital in Poznań
  • Department of Cardiac Surgery, J. Struś Hospital in Poznań
  • Chair and Department of Intensive Cardiac Care and Internal Medicine, Medical University in Poznań
  • Chair and Department of Intensive Cardiac Care and Internal Medicine, Medical University in Poznań

References

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  • Petersen S, Peto V, Rayner M: European cardio-vascular disease statistics 2005 edition. Department of Public Health, University of Oxford. http://www.heartstats.org/datapage.asp?id=1570.
  • Sans S, Kesteloot H, Kromhout D: The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Car-diovascular Mortality and Morbidity Statistics in Europe. Eur Heart J 1997; 18: 1231-48.[Crossref]
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  • Carson JL, Scholz PM, Chen AY et al.: Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol 2002; 40: 424-27.
  • Wahab NN, Cowden EA, Pearce NJ et al.: Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J Am Coll Cardiol 2002; 40: 1748-54.[PubMed][Crossref]
  • Capes SE, Hunt D, Malmberg K et al.: Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000; 355: 773-78.
  • Malmberg K, Yusuf S, Gerstein HC et al.: Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS Registry. Circulation 2000; 102: 1014-19.[Crossref][PubMed]
  • Herlitz J, Wognsen G, Emanuelsson H et al.: Mortality and morbidity in diabetic and nondiabetic patients during a 2-year period after coronary artery by-pass grafting. Diabetes Care 1996; 19: 698-703.
  • Rady MY, Ryan T, Starr NJ: Perioperative determinants of morbidity and mortality in elderly patients undergoing cardiac surgery. Crit Care Med 1998; 26: 225-35.[PubMed][Crossref]
  • Roghi A, Palmieri B, Crivellaro W et al.: Relationship of unrecognized myocardial infarction, diabetes mellitus and type of surgery to postoperative cardiac outcomes in vascular surgery. Eur J Vasc Endovasc Surg 2001; 21: 9-16.[Crossref]
  • Horan TC, Gaynes RP, Martone WJ et al.: CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606-08.
  • Finlay A. McAlister, Jeremy Man, Lana Bistritz et al.: Diabetes and Coronary Artery By-pass Surgery. An examination of perioperative glycemic control and outcomes. Diabetes Care 2003; 26:1518-24.
  • Anderson RE, Klerdal K, Ivert T et al.: Are even impaired fasting blood glucose levels preoperatively associated with increased mortality after CABG surgery? Eur Heart J 2005; 26: 1513-18.[PubMed][Crossref]
  • Ghali WA, Quan H, Brant R: Coronary artery by-pass grafting in Canada: national and provincial mortality trends, 1992-1995. Can Med Assoc J 1998; 159: 25-31.
  • Paz MA, Lupon J, Bosch X et al.: Predictors of early saphenous vein aortocoronary by-pass graft occlusion. The GESIC Study Group. Ann Thorac Surg 1993; 56: 1101-06.[Crossref]
  • Jae-Sung Choi, Kwang Ree Cho, Ki-Bong Kim: Does Diabetes Affect the Postoperative Outcomes After Total Arterial Off-Pump Coronary By-pass Surgery in Multivessel Disease? Ann Thorac Surg 2005; 80: 1353-60.
  • Utley JR, Thomason ME, Wallace DJ et al.: Preoperative correlates of impaired wound healing after saphenous vein excision. J Thorac and Card Surg 1989; 98: 147-49.
  • Harrington G, Russo P, Spelman D et al.: Surgical-site infection rates and risk factor analysis in coronary artery by-pass graft surgery. Infect Control Hosp Epidemiol 2004; 25: 472-76.

Document Type

Publication order reference

Identifiers

YADDA identifier

bwmeta1.element.-psjd-doi-10_2478_v10035-007-0077-8
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