Original ArticlesEvaluation of Outcomes and Complications in Patients Who Experience Hypoglycemia After Cardiac Surgery
Section snippets
INTRODUCTION
Both hyper- and hypoglycemia are common in hospitalized patients. Studies have identified hyperglycemia as an independent risk factor for poor clinical outcomes regardless of diabetes status (1., 2., 3., 4., 5., 6., 7., 8., 9.). Inconsistent benefits and worsening of hypoglycemia risk with intensive glycemic control prompted a shift of recommendations from the American Association of Clinical Endocrinologists and the American Diabetes Association in 2009 to higher glucose targets for inpatients
Study Design
A retrospective electronic medical record (EMR) review of patients who underwent cardiac surgery that involved coronary artery bypass grafting (CABG) and/or cardiac valve repair/replacement and had postoperative insulin management by the Northwestern Glucose Management Service (GMS) between September 4, 2007, and April 30, 2011, at Northwestern Memorial Hospital (NMH) was performed with approval by the Northwestern University Institutional Review Board (IRB), as previously reported (12).
RESULTS
The demographic characteristics of the original groups are shown in Table 1, comparing patients with hypoglycemia (n = 215) and those without hypoglycemia (n = 1,110). Patients experiencing hypoglycemia were more likely to be less overweight, female, have pre-existing diabetes, and have a prior history of cerebrovascular disease, with a trend towards greater decrease in renal function.
When comparing 30-day outcomes between those with hypoglycemia and those without hypoglycemia in the original
DISCUSSION
Hyperglycemia is an independent risk factor for poor clinical outcomes, particularly in hospitalized patients (1., 2., 3., 4., 5., 6., 7., 8., 9.). The role of hypoglycemia in patient outcomes and mortality has come to light in the wake of studies in which strict glycemic control was implemented. In our study, we found no increase in adverse outcomes within the first 30 days following surgery related to all patients experiencing hypoglycemia. However, when patients were subdivided into those
CONCLUSION
In conclusion, hypoglycemia from intensive postoperative glycemic management is common. While there do not appear to be increased adverse outcomes from surgery in the first 30 days postoperatively with single episodes of hypoglycemia, there are increased adverse outcomes and there may be a significant risk of increased long-term mortality in patients who experience more than one episode of hypoglycemia in the first 3 postoperative days. Thus, a single episode of hypoglycemia is common and
ACKNOWLEDGMENT
We thank the many nurses and physicians who participated in the care of these patients.
The results of this study have been presented, in part, previously (Lowden E, Schmidt K, Mulla I, et al. Evaluation of postoperative hypoglycemia in cardiac surgery patients: comparison of outcomes and complications. Presented at: 98th Annual Meeting of The Endocrine Society; April, 2016; Boston, MA. Abstract #694).
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DISCLOSURE
The authors have no multiplicity of interest to disclose.