Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery

Andra E. Duncan, Alaa Abd-Elsayed, Ankit Maheshwari, Meng Xu, Edward Soltesz, Colleen Koch

Research output: Contribution to journalArticle

Abstract

Background: Severe hyperglycemia is associated with adverse outcomes after cardiac surgery. Whether intraoperative and postoperative glucose concentrations equally impact outcomes is unknown. The objective of this investigation was to compare the ability of perioperative glucose concentrations and glycemic variability to predict adverse outcomes. Risk associated with decreasing increments of glucose concentrations, hypoglycemia, and diabetic status was also examined. METHODS:: This retrospective analysis of prospectively collected data included 4,302 patients who underwent cardiac surgery between October 3, 2005 and May 31, 2007 at the Cleveland Clinic. Time-weighted mean intraoperative (GlcOR) and postoperative (GlcICU) glucose concentrations were calculated. Patients were categorized as follows: Glc more than 200, 171-200, 141-170, and less than or equal to 140 mg/dl. Coefficient of variation was used to calculate glycemic variability. Logistic regression model with backward selection assessed the relationship between glucose concentrations, variability, and adverse outcomes while adjusting for potential confounders. Another model assessed the predictability of GlcOR and Glc ICU on adverse outcomes. Results:Both GlcOR and Glc ICU predicted risk for mortality and morbidity. Increased postoperative glycemic variability was associated with increased risk for adverse outcomes. Severe hyperglycemia (GlcOR and GlcICU > 200 mg/dl) was associated with worse outcomes; however, decreasing increments of GlcOR did not consistently reduce risk. Glc OR less than or equal to 140 mg/dl was not associated with improved outcomes compared with severe hyperglycemia, despite infrequent hypoglycemia. Diabetic status did not influence the effects of hyperglycemia. CONCLUSION:: Perioperative glucose concentrations and glycemic variability are important in predicting outcomes after cardiac surgery. Incremental decreases of intraoperative glucose concentrations did not consistently reduce risk. Despite rare hypoglycemia, intraoperative glucose concentrations closest to normoglycemia were associated with worse outcomes.

Original languageEnglish (US)
Pages (from-to)860-871
Number of pages12
JournalAnesthesiology
Volume112
Issue number4
DOIs
StatePublished - Apr 2010
Externally publishedYes

Fingerprint

Thoracic Surgery
Blood Glucose
Glucose
Hyperglycemia
Hypoglycemia
Logistic Models
Morbidity
Mortality

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. / Duncan, Andra E.; Abd-Elsayed, Alaa; Maheshwari, Ankit; Xu, Meng; Soltesz, Edward; Koch, Colleen.

In: Anesthesiology, Vol. 112, No. 4, 04.2010, p. 860-871.

Research output: Contribution to journalArticle

Duncan, Andra E. ; Abd-Elsayed, Alaa ; Maheshwari, Ankit ; Xu, Meng ; Soltesz, Edward ; Koch, Colleen. / Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery. In: Anesthesiology. 2010 ; Vol. 112, No. 4. pp. 860-871.
@article{653d92ab979849778dd2c8fab2b9f2d4,
title = "Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery",
abstract = "Background: Severe hyperglycemia is associated with adverse outcomes after cardiac surgery. Whether intraoperative and postoperative glucose concentrations equally impact outcomes is unknown. The objective of this investigation was to compare the ability of perioperative glucose concentrations and glycemic variability to predict adverse outcomes. Risk associated with decreasing increments of glucose concentrations, hypoglycemia, and diabetic status was also examined. METHODS:: This retrospective analysis of prospectively collected data included 4,302 patients who underwent cardiac surgery between October 3, 2005 and May 31, 2007 at the Cleveland Clinic. Time-weighted mean intraoperative (GlcOR) and postoperative (GlcICU) glucose concentrations were calculated. Patients were categorized as follows: Glc more than 200, 171-200, 141-170, and less than or equal to 140 mg/dl. Coefficient of variation was used to calculate glycemic variability. Logistic regression model with backward selection assessed the relationship between glucose concentrations, variability, and adverse outcomes while adjusting for potential confounders. Another model assessed the predictability of GlcOR and Glc ICU on adverse outcomes. Results:Both GlcOR and Glc ICU predicted risk for mortality and morbidity. Increased postoperative glycemic variability was associated with increased risk for adverse outcomes. Severe hyperglycemia (GlcOR and GlcICU > 200 mg/dl) was associated with worse outcomes; however, decreasing increments of GlcOR did not consistently reduce risk. Glc OR less than or equal to 140 mg/dl was not associated with improved outcomes compared with severe hyperglycemia, despite infrequent hypoglycemia. Diabetic status did not influence the effects of hyperglycemia. CONCLUSION:: Perioperative glucose concentrations and glycemic variability are important in predicting outcomes after cardiac surgery. Incremental decreases of intraoperative glucose concentrations did not consistently reduce risk. Despite rare hypoglycemia, intraoperative glucose concentrations closest to normoglycemia were associated with worse outcomes.",
author = "Duncan, {Andra E.} and Alaa Abd-Elsayed and Ankit Maheshwari and Meng Xu and Edward Soltesz and Colleen Koch",
year = "2010",
month = "4",
doi = "10.1097/ALN.0b013e3181d3d4b4",
language = "English (US)",
volume = "112",
pages = "860--871",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Role of intraoperative and postoperative blood glucose concentrations in predicting outcomes after cardiac surgery

AU - Duncan, Andra E.

AU - Abd-Elsayed, Alaa

AU - Maheshwari, Ankit

AU - Xu, Meng

AU - Soltesz, Edward

AU - Koch, Colleen

PY - 2010/4

Y1 - 2010/4

N2 - Background: Severe hyperglycemia is associated with adverse outcomes after cardiac surgery. Whether intraoperative and postoperative glucose concentrations equally impact outcomes is unknown. The objective of this investigation was to compare the ability of perioperative glucose concentrations and glycemic variability to predict adverse outcomes. Risk associated with decreasing increments of glucose concentrations, hypoglycemia, and diabetic status was also examined. METHODS:: This retrospective analysis of prospectively collected data included 4,302 patients who underwent cardiac surgery between October 3, 2005 and May 31, 2007 at the Cleveland Clinic. Time-weighted mean intraoperative (GlcOR) and postoperative (GlcICU) glucose concentrations were calculated. Patients were categorized as follows: Glc more than 200, 171-200, 141-170, and less than or equal to 140 mg/dl. Coefficient of variation was used to calculate glycemic variability. Logistic regression model with backward selection assessed the relationship between glucose concentrations, variability, and adverse outcomes while adjusting for potential confounders. Another model assessed the predictability of GlcOR and Glc ICU on adverse outcomes. Results:Both GlcOR and Glc ICU predicted risk for mortality and morbidity. Increased postoperative glycemic variability was associated with increased risk for adverse outcomes. Severe hyperglycemia (GlcOR and GlcICU > 200 mg/dl) was associated with worse outcomes; however, decreasing increments of GlcOR did not consistently reduce risk. Glc OR less than or equal to 140 mg/dl was not associated with improved outcomes compared with severe hyperglycemia, despite infrequent hypoglycemia. Diabetic status did not influence the effects of hyperglycemia. CONCLUSION:: Perioperative glucose concentrations and glycemic variability are important in predicting outcomes after cardiac surgery. Incremental decreases of intraoperative glucose concentrations did not consistently reduce risk. Despite rare hypoglycemia, intraoperative glucose concentrations closest to normoglycemia were associated with worse outcomes.

AB - Background: Severe hyperglycemia is associated with adverse outcomes after cardiac surgery. Whether intraoperative and postoperative glucose concentrations equally impact outcomes is unknown. The objective of this investigation was to compare the ability of perioperative glucose concentrations and glycemic variability to predict adverse outcomes. Risk associated with decreasing increments of glucose concentrations, hypoglycemia, and diabetic status was also examined. METHODS:: This retrospective analysis of prospectively collected data included 4,302 patients who underwent cardiac surgery between October 3, 2005 and May 31, 2007 at the Cleveland Clinic. Time-weighted mean intraoperative (GlcOR) and postoperative (GlcICU) glucose concentrations were calculated. Patients were categorized as follows: Glc more than 200, 171-200, 141-170, and less than or equal to 140 mg/dl. Coefficient of variation was used to calculate glycemic variability. Logistic regression model with backward selection assessed the relationship between glucose concentrations, variability, and adverse outcomes while adjusting for potential confounders. Another model assessed the predictability of GlcOR and Glc ICU on adverse outcomes. Results:Both GlcOR and Glc ICU predicted risk for mortality and morbidity. Increased postoperative glycemic variability was associated with increased risk for adverse outcomes. Severe hyperglycemia (GlcOR and GlcICU > 200 mg/dl) was associated with worse outcomes; however, decreasing increments of GlcOR did not consistently reduce risk. Glc OR less than or equal to 140 mg/dl was not associated with improved outcomes compared with severe hyperglycemia, despite infrequent hypoglycemia. Diabetic status did not influence the effects of hyperglycemia. CONCLUSION:: Perioperative glucose concentrations and glycemic variability are important in predicting outcomes after cardiac surgery. Incremental decreases of intraoperative glucose concentrations did not consistently reduce risk. Despite rare hypoglycemia, intraoperative glucose concentrations closest to normoglycemia were associated with worse outcomes.

UR - http://www.scopus.com/inward/record.url?scp=77950860949&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77950860949&partnerID=8YFLogxK

U2 - 10.1097/ALN.0b013e3181d3d4b4

DO - 10.1097/ALN.0b013e3181d3d4b4

M3 - Article

C2 - 20216389

AN - SCOPUS:77950860949

VL - 112

SP - 860

EP - 871

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 4

ER -