Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery.

Abstract

PURPOSE:

This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications.

METHODS:

In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications.

RESULTS:

Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications.

CONCLUSION:

Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.

• Authors: Hiroki Sato, Michihiro Hosojima, Tomomi Ishikawa, Kenji Aoki, Takeshi Okamoto, Akihiko Saito, Masanori Tsuchida
• Journal: Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia (Ann Thorac Cardiovasc Surg) Vol. 23 Issue 5 Pg. 239-247 (Oct 20 2017) ISSN: 2186-1005 [Electronic] Japan
• PMID: 28717057 (Publication Type: Journal Article)

Chemical References

• Biomarkers
• Blood Glucose
• Hypoglycemic Agents
• Insulin

Topics

• Aged
• Atrial Fibrillation (diagnosis, etiology)
• Biomarkers (blood)
• Blood Glucose (drug effects, metabolism)
• Cardiac Surgical Procedures (adverse effects)
• Eating
• Female
• Glucose Metabolism Disorders (blood, diagnosis, drug therapy, etiology)
• Humans
• Hypoglycemic Agents (administration & dosage)
• Infusions, Intravenous
• Injections, Subcutaneous
• Insulin (administration & dosage)
• Male
• Middle Aged
• Monitoring, Physiologic (instrumentation, methods)
• Predictive Value of Tests
• Program Evaluation
• Prospective Studies
• Risk Factors
• Surgical Wound Infection (diagnosis, etiology)
• Time Factors
• Treatment Outcome