Insulin Use and Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Graft Surgery

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 35; no. 5; pp. 666 - 674
• Main Authors: Ranney, David N, Williams, Judson B, Albrecht, Álvaro S, Li, Shuang, Kalil, Renato A K, Peterson, Eric D, Lopes, Renato D
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01-01-2020
• Subjects: Blood Glucose; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiovascular disease; Clinical outcomes; Coronary Artery Bypass; Coronary vessels; Data collection; Diabetes; Diabetes Mellitus - drug therapy; Ejection fraction; Glucose; Heart surgery; Hospitals; Humans; Hyperglycemia; Insulin - therapeutic use; Insulin resistance; Insulin, Regular, Human; Intensive care; Intensive Care Units; Logistic Models; Male; Mortality; Operating Rooms; Original; Patients; Risk Factors; Surgeons; SURGERY; Treatment Outcome; United States; United States; United States > US; Coronary Artery Bypass; Operating Rooms; Blood Glucose; Logistic Models; Intensive Care Units; Insulin, Regular, Human
• ISSN: 1678-9741; 0102-7638; 1678-9741
• DOI: 10.21470/1678-9741-2019-0347

To describe insulin use and postoperative glucose control in patients undergoing coronary artery bypass graft (CABG) surgery.
We examined 2,390 patients with and without diabetes enrolled in the Contemporary Analysis of Perioperative Cardiovascular Surgical Care (CAPS-Care) Study who underwent CABG surgery (01/2004 - 06/2005) to describe postoperative insulin use, variation in insulin use across different hospitals, and associated in-hospital complications and clinical outcomes. Logistic regression was used to assess the adjusted relationship between insulin use and clinical outcomes.
Overall, insulin was used in 82% (n=1,959) of patients, including 95% (n=1,203) with diabetes (n=1,258) and 67% (n=756) without diabetes (n=1,132). Continuous insulin was used in 35.5% of patients in the operating room and in 56% in the intensive care unit. Continuous insulin use varied significantly among centers from 8-100% in patients with diabetes. When compared with all patients not receiving insulin, insulin use in patients without diabetes was associated with a higher rate of death or major complication (adjusted odds ratio [OR]=1.54; 95% confidence interval [CI] 1.15-2.04; P=0.003). In patients with diabetes, insulin use was not associated with a higher risk of adverse outcomes (adjusted OR=1.01; 95% CI 0.52-1.98; P=0.98).
The postoperative use of insulin is high among CABG patients in the United States of America. Insulin use in patients without diabetes was associated with worse clinical outcomes compared to patients (both with and without diabetes) who did not receive insulin. Further investigation is needed to determine the optimal use of postoperative insulin after CABG.