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

• Authors: Krzysztof Greberski , Paweł Bugajski , Ryszard Kalawski , Przemysław Guzik , Henryk Wysocki
• Languages of publication: 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.

Keywords

EN

coronary artery by-pass surgery; OPCAB; postoperative complications; diabetes mellitus; impaired glucose metabolism

• Publisher: Index Copernicus International
• Journal: Polish Journal of Surgery
• Year: 2007
• Volume: 79
• Issue: 7
• Pages: 496-502

Dates

published

1 - 7 - 2007

online

27 - 11 - 2007

Contributors

author

Krzysztof Greberski

• Department of Cardiac Surgery, J. Struś Hospital in Poznań

author

Paweł Bugajski

• Department of Cardiac Surgery, J. Struś Hospital in Poznań

author

Ryszard Kalawski

• Department of Cardiac Surgery, J. Struś Hospital in Poznań

author

Przemysław Guzik

• Chair and Department of Intensive Cardiac Care and Internal Medicine, Medical University in Poznań

author

Henryk Wysocki

• Chair and Department of Intensive Cardiac Care and Internal Medicine, Medical University in Poznań

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Identifiers

DOI

10.2478/v10035-007-0077-8