CLINICAL STUDY
Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery
Jeffrey L. Carson, MD*,*,
Peter M. Scholz, MD ,
Anita Y. Chen, MS ,
Eric D. Peterson, MD, MPH, FACC,
Jeffrey Gold, MD, FACC || and
Stephen H. Schneider, MD¶
* Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Outcomes Research and Assessment Group, New Brunswick, New Jersey, USA
Department of Medicine, and Division of Cardiothoracic Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Outcomes Research and Assessment Group, New Brunswick, New Jersey, USA
Department of Surgery, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
¶ Division of Endocrinology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Outcomes Research and Assessment Group, New Brunswick, New Jersey, USA
|| Division of Cardiovascular Surgery, Albert Einstein College of Medicine, New York, New York, USA
Manuscript received October 10, 2001;
revised manuscript received January 31, 2002,
accepted April 30, 2002.
* Reprint requests and correspondence: Dr. Jeffrey L. Carson, Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey 08903, USA.
Carson{at}umdnj.edu
OBJECTIVES: The aim of this study was to determine the impact of diabetes mellitus (DM) on short-term mortality and morbidity in patients undergoing coronary artery bypass surgery (CABG).
BACKGROUND: Diabetes mellitus is present in approximately 20% to 30% of patients undergoing CABG, and the impact of diabetes on short-term outcome is unclear.
METHODS: We performed a retrospective cohort study in 434 hospitals from North America. The study population included 146,786 patients undergoing CABG during 1997: 41,663 patients with DM and 105,123 without DM. The primary outcome was 30-day mortality. Secondary outcomes were in-hospital morbidity, infections and composite outcomes of mortality or morbidity and mortality or infection.
RESULTS: The 30-day mortality was 3.7% in patients with DM and 2.7% in those without DM; the unadjusted odds ratio was 1.40 (95% confidence interval [CI], 1.31 to 1.49). After adjusting for other baseline risk factors, the overall adjusted odds ratio for diabetics was 1.23 (95% CI, 1.15 to 1.32). Patients treated with oral hypoglycemic medications had adjusted odds ratio 1.13; 95% CI, 1.04 to 1.23, whereas those on insulin had an adjusted odds ratio 1.39; 95% CI, 1.27 to 1.52. Morbidity, infections and the composite outcomes occurred more commonly in diabetic patients and were associated with an adjusted risk about 35% higher in diabetics than nondiabetics, particularly among insulin-treated diabetics (adjusted risk between 1.5 to 1.61).
CONCLUSIONS: Diabetes mellitus is an important risk factor for mortality and morbidity among those undergoing CABG. Research is needed to determine if good control of glucose levels during the perioperative time period improves outcome.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass grafting | | CI | | confidence interval | | CK | | creatine kinase | | DM | | diabetes mellitus | | LDH | | lactase dehydrogenase | | MI | | myocardial infarction |
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