O19 Adequate hyperglycemia management in inmediate post-operative period is associated with less complications in patients who underwent myucardial revascularization surgery

Abstract

Introduction: Hyperglycemia in hospitalization (glycemia ≥140 mg/dl) is a frequent event during the perioperative period for cardiovascular surgery (CVS), happening in an 80% of patients with diabetes mellitus (DM) and between 12 to 30% in patients without previous DM (inpatient stress hyperglycemia [HGE]), associated with a higher mortality rate.

Objective: To describe the frequency of post operatory (PO) complications and their relation to the degree of glycaemic control in patients, adults older than 40 years old, who had undergone myocardial revascularization surgery (MRS), and who followed a standard protocol of glycaemia control during their hospital stay.

Materials and Methods: Observational prospective cohort study. It included 80 patients of middle age 71.08 ± 5.66 years, who had undergone MRS between June 2019 and March 2020. On the other hand, it excluded- patients who presented ketoacidosis or hyperosmolar syndrome. The glycaemia was controlled with capillary monitoring. 42.5% was classified as known DM, 7.5% as unknown DM (both considered DM) and 50% as HGE. Additionally, they were divided according to the degree of glycaemic control in the post operatory first 24 hours. 1) optimum: patients with an average glycemia of ≤180 mg/dl and with no hypoglycemia (glycemia ≤70 mg/dl); 2) non – optimum: patients with an average glycemia of >180 mg/dl. Severity and types of post-operative complications were both assessed. A logistic regression model was built among the variables: age, type of hyperglycaemia, surgery duration, glycaemic control, punctuations in the Cardiac Anesthesia Risk Evaluation Score (CARE), EuroSCOREII, Charlson comorbidities, and the presence or absence of PO complications. In order to be included in the multivariate model, variables with p<0.05 were contemplated as significative. The study was approved by the Ethics Committee and the Institutional Review Board.

Results: In the PO period, 71.25% of the patients reached an optimum glycemic control and presented less complications compared to the non-optimum control group 52.63% vs 82.60%, p=0.021), with a significative reduction of the PO complications risk. (RR of 0.63 [IC 95% 0.46 – 0.86]), with less frequency of renal events (17.54% vs 43.48%, p=0.022) RR 0.40 [IC 95% 0.19 – 0.83].
49 patients presented complications, with de novo or decompensation arrhythmia in a 44.89%. Those patients who presented PO complications vs. those who did not present PO complications had: a higher EuroSCOREII score (1.63 [1.40 – 2.49] vs 1.33 [1.09 – 1.92], p=0.009), a higher average of blood glucose levels in PO 24 hours (169.82 mg/dl
[159.42 – 192.21] vs 154.86 mg/dl [139.67 – 171.33]) and a higher glycemic variability
coefficient (19.06% [13.68 – 22.56] vs 14.45% [9.44 – 18.29], p=0.032). On the subanalysis regarding hyperglycaemia type, no significative differences were found in respect to post-operative complications.

Conclusions: Our study’s preliminary findings support the hypothesis of that an optimum glycaemic control (glycemia ≤180 mg/dl) in the immediate PO period of an MRS, through a protocol for standardized control of a hyperglycemia, is associated with a drop of the risk of presenting PO complications. In our study, this significative reduction was of 37%.