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Non-infective morbidity in diabetic patients undergoing coronary and heart valve surgery

Cardiothoracic centre, Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire, United Kingdom

Received 12 June 2008; received in revised form 15 August 2008; accepted 18 August 2008.

^_* Corresponding author. Address: Department of Cardiothoracic Surgery, Castle Hill Hospital, Kingston-Upon-Hull, East Yorkshire HU16 5JQ, United Kingdom. Tel.: +44 1482 623256; fax: +44 1482 623257. (Email: dngaage{at}yahoo.com).

Objective: Studies of postoperative morbidity in diabetics have focussed on infection; however, autonomic and cardiovascular complications of diabetes potentially increase the risk for non-infective morbidity. We sought to investigate major non-infective early postoperative complications in diabetic patients. Methods: We identified diabetics who underwent CABG and/or valve operation from 1998 through 2007, and compared their clinical characteristics and outcome with a contemporaneous cohort of non-diabetic patients. Results: The demographic characteristics of 1145 diabetics were similar to 5534 non-diabetic patients (mean age 66 ± 9 years vs 66 ± 10 years, p = 0.45, female 27.5% vs 26.7%, p = 0.59, respectively). Class III/IV angina symptoms (43.9% vs 34.9%, p < 0.0001), intravenous nitrates therapy (10.4% vs 6.6%, p < 0.0001), heart failure (24.8% vs 20.4%, p = 0.001), prior myocardial infarction (37% vs 31%, p < 0.0001), ejection fraction 0.50 (34.5% vs 23.0%, p < 0.0001), triple vessel disease (66.3% vs 54.8%, p < 0.0001), renal insufficiency (3.6% vs 1.5%, p < 0.0001) and peripheral vascular disease (16.1% vs 8.7%) were prevalent amongst diabetics. The predominant operation was CABG (diabetic 84.8% vs non-diabetic 73.9%). Low cardiac output (28.3% vs 24.0%, p = 0.002), renal dialysis (2.0% vs 0.8%, p < 0.0001) and cerebrovascular events (5.1% vs 3.8%, p = 0.04) more often complicated recovery of diabetic patients, but operative mortality was similar for both groups. However, postoperative myocardial infarction was less common in diabetics (0.5% vs 1.4%, p = 0.02). Diabetes was not a risk factor for the composite endpoint of major non-infective morbidity and operative mortality (OR 1.15, 95% CI 0.97–1.37, p = 0.10). Diabetic patients were prone to longer postoperative hospitalisation (9.7±10.5 days vs 8.4 ± 6.7 days, p < 0.0001) and discharge to a convalescence facilities (9.8% vs 6.9%, p < 0.0001). Conclusions: Diabetic patients present for surgery with higher prevalence of cardiovascular risk factors and are more likely to develop major non-infective complications, including cardiac, renal and neurological dysfunction, even though diabetes does not directly influence non-infective postoperative morbidity following CABG and/or valve operations.

Key Words: Diabetes • Coronary artery bypass grafting • Heart valve repair/replacement • Outcomes (morbidity/mortality)

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