The aim of this study is to evaluate evaluated the impact of preoperative HbA1c in diabetic patients on perioperative glycemic variability and outcome after off-pump coronary artery bypass (OPCAB). The medical records of patients who had a preoperative diagnosis of diabetes and underwent OPCAB from 2005 to 2017 will be reviewed. Patients are divided by HbA1c levels (\<7.0% or ≥7.0%). Glycemic variability during surgery and up to 24 hours after surgery is assessed by the coefficient of variation. The primary outcome is defined as a composite of postoperative permanent stroke, prolonged ventilation, deep sternal wound infection, renal failure, reoperation, mortality according to the definition of STS (Society of Thoracic Surgery) version 2.81 adult cardiac surgery database. If one or more of the above five morbidity or mortality occur, it is assumed that composite morbidity/mortality had occurred. We compare postoperative complications, mortality and perioperative glycemic variability between patients with HbA1c ≥7.0% and \<7.0%, and examined the effects of perioperative glycemic control on postoperative morbidity and mortality (composite morbidity/mortality).
Study Type
OBSERVATIONAL
Enrollment
703
Off-Pump Coronary Artery Bypass (OPCAB) surgery. This study is retrospective study
Department of Anesthesiology & Pain Medicine, Yonsei university college of medicine
Seoul, South Korea
Incidence of Permanent stroke
postoperative stroke (i.e., any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain that did not resolve within 24 hours.)
Time frame: during the hospitalization for surgery (up to 30 days)
Incidence of Renal failure
1. Increase in serum creatinine level 3.0 x greater than baseline, or serum creatinine level ≥ 4 mg/dL. The acute rise must be at least 0.5 mg/dl. 2. A new requirement for dialysis postoperatively.
Time frame: during the hospitalization for surgery (up to 30 days)
Incidence of Prolonged ventilation
Prolonged post-operative pulmonary ventilation \> 24.0 hours. The hours of postoperative ventilation time include OR exit until extubation, plus any additional hours following reintubation.
Time frame: during the hospitalization for surgery (up to 30 days)
Incidence of Deep sternal wound infection
Deep sternal wound infection or mediastinitis including muscle layer according to CDC definition
Time frame: during the hospitalization for surgery (up to 30 days)
Incidence of Re-operation for any reason
reoperation for bleeding/tamponade, valvular dysfunction, graft occlusion, other cardiac reason, or non-cardiac reason
Time frame: during the hospitalization for surgery (up to 30 days)
Operative mortality
all deaths, regardless of cause
Time frame: during the hospitalization for surgery (up to 30 days)
Perioperative Coefficient of variation of glucose
the standard deviation divided by the average of blood glucose concentration during surgery and first 24 hours after surgery
Time frame: During surgery and up to the first 24 hours after surgery
Incidence of Perioperative Coefficient of variation of glucose
the standard deviation of blood glucose concentration during surgery and first 24 hours after surgery
Time frame: During surgery and up to the first 24 hours after surgery
Perioperative mean glucose
average of blood glucose concentration during surgery and first 24 hours after surgery
Time frame: During surgery and up to the first 24 hours after surgery
Perioperative time-weighted average glucose
time-weighted average of blood glucose concentration during surgery and first 24 hours after surgery
Time frame: During surgery and up to the first 24 hours after surgery
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