scholarly journals The Association of Perioperative Glycemic control with Post-operative wound Infection after Coronary Artery Bypass Grafting in Veterans with Diabetes Mellitus

2021 ◽  
Author(s):  
Yakov Elgudin ◽  
Salil V Deo ◽  
Joseph Rubelowsky ◽  
Brian Cmolik
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Glycemic Control ◽  
Wound Infection ◽  
Blood Sugar ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Group Iii ◽  
Increased Risk ◽  
Hba1c Levels

Abstract Introduction: After coronary artery bypass (CABG), diabetes mellitus is associated with increased risk of infection. We model the inter-relationship of pre- and post-operative glycemic control and their composite influence on post-operative wound infection. Methods: 2,899 Veterans that underwent isolated CABG were stratified (Group I: < 8%, Group II: 8 - 10%, Group III: > 10%) according to preoperative HbA1c levels. We obtained the median blood sugar level (BSL) on post-operative days 0 - 4 (POD) and compared trends in BSL readings according to HbA1c groups. We fit a multi-variable random effects mixed model to understand the odds (OR) of developing postoperative mediastinitis. A two-stage joint model was fit to evaluate the adjusted hazard (HR) of pre-operative HbA1c, post-operative BSL and clinical factors on 90-day readmission for infection. Results: In groups I, II, and III had 66%, 25% and 9% patients respectively. In 148,810 post-operative BSL readings, median BSL values peaked at POD 2 (145 mg/dl). In group III, 29% BSL reading was above the recommended limit (< 180 mg/dl). Group III (OR 3.5; p < 0.01) and COPD (OR 2.51; p < 0.01) were associated with higher rates of mediastinitis. Groups II (HR 1.4; p = 0.01) and III (HR 1.5; p = 0.04) were associated with increased risk for 90-day readmission for infection. Post-operative blood sugar levels (p = 0.5) were not associated with increased risk for wound infection at 90 days. Conclusion: Among Veterans undergoing coronary artery bypass, a large proportion had HbA1c levels > 8%. In the post-operative period, 22% of the blood sugar readings are higher than 180 mg/dl. Preoperative HbA1c (rather than postoperative glycemic control) is associated with higher rates of deep sternal wound infection.

Aprotinin causes no increased risk of organ dysfuntion in coronary artery bypass procedures

2009 ◽  
Vol 56 (S 01) ◽  
Author(s):  
G Goerlach ◽  
C Immler ◽  
P Roth ◽  
T Attmann ◽  
A Boening
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Increased Risk

Assessment of the Radial Artery and Hand Circulation by Computed Tomography Angiography: A Pilot Study

2005 ◽  
Vol 8 (1) ◽  
pp. 28 ◽  
Author(s):  
Omer Faruk Dogan ◽  
Musturay Karcaaltincaba ◽  
Umit Duman ◽  
Deniz Akata ◽  
Aytekin Besim ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Radial Artery ◽  
Anatomic Variation ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Preoperative Imaging ◽  
Median Artery ◽  
Test Result

Objectives: The radial artery (RA) is increasingly being used as a coronary bypass graft. Results of a previous study using Doppler ultrasound and histopathologic examinations indicated that the RA has a higher incidence of preexisting intimal hyperplasia, medial calcification, and atherosclerosis than the internal thoracic artery. The aims of this study were to evaluate the use of computed tomographic angiography (CTA) to display hand collateral circulation, to define the criteria for an abnormal CTA test result, and to demonstrate usefulness of CTA as an alternative to conventional angiography for evaluation of the radial artery. Materials and Methods: Sixteen patients scheduled for coronary artery bypass grafting entered this study. We performed 32 examinations of forearm and hand arterial anatomy in these patients. CTA was performed in patients with a normal Allen test result, except 1 patient who had a persistent median artery. Soft tissue density forehand roentgenography was performed in all patients before the CTA evaluation. There was no selection of patients in relation to patient characteristics. As a risk factor for radial artery calcification, 6 of the patients had diabetes mellitus, 6 had aortofemoral occlusive disease, and 4 had a history of smoking. Results: Bilateral forearm arteries were visualized in all patients. Severe RA calcification was found in 1 patient, and distal occlusion was found in another patient. Focal RA calcification was noted in 2 patients. In the remaining patients no radial artery calcification or occlusion was noted. Anatomic variation of the upper limb arteries was shown in 2 patients; these variations were persistent median artery with absence of the radial and ulnar arteries and high bifurcation of the radial artery from the brachial artery. Conclusion: CTA is useful and safe for detection of radial artery calcific disease and assessment of the forehand circulation and its anatomic variations. Preoperative imaging of the RA is a means to avoid unnecessary forearm exploration or inadvertent use of a diseased conduit in coronary artery bypass candidates with multiple risk factors such as diabetes mellitus.

Renal Failure after Coronary Bypass Surgery and the Associated Risk Factors

2015 ◽  
Vol 18 (1) ◽  
pp. 006
Author(s):  
Hasan Reyhanoglu ◽  
Kaan Ozcan ◽  
Murat Erturk ◽  
Fatih İslamoglu ◽  
İsa Durmaz
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Failure ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Significant Risk ◽  
High Morbidity ◽  
Factors Associated

<strong>Objective:</strong> We aimed to evaluate the risk factors associated with acute renal failure in patients who underwent coronary artery bypass surgery.<br /><strong>Methods:</strong> One hundred and six patients who developed renal failure after coronary artery bypass grafting (CABG) constituted the study group (RF group), while 110 patients who did not develop renal failure served as a control group <br />(C group). In addition, the RF group was divided into two subgroups: patients that were treated with conservative methods without the need for hemodialysis (NH group) and patients that required hemodialysis (HR group). Risk factors associated with renal failure were investigated.<br /><strong>Results:</strong> Among the 106 patients that developed renal failure (RF), 80 patients were treated with conservative methods without any need for hemodialysis (NH group); while <br />26 patients required hemodialysis in the postoperative period (HR group). The multivariate analysis showed that diabetes mellitus and the postoperative use of positive inotropes and adrenaline were significant risk factors associated with development of renal failure. In addition, carotid stenosis and postoperative use of adrenaline were found to be significant risk factors associated with hemodialysis-dependent renal failure (P &lt; .05). The mortality in the RF group was determined as 13.2%, while the mortality rate in patients who did not require hemodialysis and those who required hemodialysis was 6.2% and 34%, respectively.<br /><strong>Conclusion:</strong> Renal failure requiring hemodialysis after CABG often results in high morbidity and mortality. Factors affecting microcirculation and atherosclerosis, like diabetes mellitus, carotid artery stenosis, and postoperative vasopressor use remain the major risk factors for the development of renal failure.<br /><br />

Factors associated with return to work after coronary artery bypass grafting (CABG)

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Raynaldo
Keyword(s):  
Diabetes Mellitus ◽  
Logistic Regression ◽  
Coronary Artery ◽  
Return To Work ◽  
Coronary Artery Bypass ◽  
Functional Capacity ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Factors Associated ◽  
Cabg Patients

Abstract Funding Acknowledgements Type of funding sources: None. Background. Postoperative CABG patients will generally experience improvement in symptoms and functional capacity. Post-CABG patients are expected to be productive again in order to have a positive impact on both patient and the society socio-economically, in addition to other parameters such as morbidity, mortality and serious adverse events. Purpose to determine the factors that associated with return to work in CABG patients in one General Hospital. Methods. We analyzed data from Adam Malik Hospital registry of 68 patients who had undergone CR after coronary artery bypass graft (CABG) in 2017-2020. The outcomes assessed were work status in 6 month after CABG. Patients’ characteristics, sociodemographic, clinical parameters of functional capacity using 6 minutes of walk test (6MWT), T2DM, Hypertension and cholesterol level were assessed. Factors associated with return to work were identified using multivariable logistic regression. Results We identified 68 patients undergoing isolated CABG (2017–2020). One year after discharge for CABG, 40 (58.8%) patients had returned to the workforce. Factors associated with return to work  were identified using bivariate logistic regression. Diabetes mellitus (odds ratio, 10.192; 95% confidence interval, 0.063–0.515). Conclusion Almost 2 from 3 patients after CABG returned to work within 6 months. Diabetes mellitus and functional capacity were associated with a lower likelihood of returning to work.

Atrial fibrillation – Can HbA1c levels really predict the risk?

2021 ◽  
pp. 021849232199893
Author(s):  
Pradeep Narayan ◽  
Chandan Kumar Mandal ◽  
Rajlakshmi Das ◽  
Debasis Das ◽  
Paramita Auddya Ghorai ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Post Operative Period ◽  
Hba1c Levels

Background Diabetes is associated with higher mortality and worse post-operative outcomes in patients undergoing coronary artery bypass grafting and HbA1c levels have consistently been reported to be associated with adverse post-operative outcomes. However, the role of HbA1c still remains unclear with regards to the occurrence of atrial fibrillation. Method Data for the patients undergoing off-pump coronary artery bypass grafting was analysed in a retrospective fashion. Patients were divided into–those with HbA1c < 6.5% and those with HbA1c ≥ 6.5% and the incidence of atrial fibrillation observed in these two groups. We also compared patient who developed atrial fibrillation in the post-operative period and compared them with those who did not. Results Of the 5259 patients included in the study HbA1c was <6.5 in 2808 (53.4%) patients and was ≥6.5 in 2451 (46.6%) patients; 623 (11.8%) patients in our study developed atrial fibrillation. Onset of atrial fibrillation in the post-operative period was seen most commonly 235 (38.3%) on between 24 and 48 h after the operation with more than half of them 338 (54.2%) occurring within the first 48 h. On multivariate analysis, HbA1c was not a risk factor for atrial fibrillation (odd’s ratio 1.144, 95% confidence interval 0.967–1.354). Only increased age (odd’s ratio 1.08; 95% confidence interval 1.069–1.091); EuroSCORE (odd’s ratio 1.073; 95% confidence interval 1.048–1.099); history of recent MI (odd’s ratio 0.768; 95% confidence interval 0.606–0.971) and peripheral vascular disease (odd’s ratio 1.667; 95% confidence interval 1.091–2.517) were found to be independently associated with increased risk of atrial fibrillation in the post-operative period. Conclusions After adjusting for confounders HbA1c levels do not independently predict risk of atrial fibrillation after off-pump coronary artery bypass grafting.

scholarly journals Hemoglobin A1c in Patients with Diabetes Predict Long-Term Mortality Following Coronary Artery Surgery

2021 ◽  
Vol 10 (12) ◽  
pp. 2739
Author(s):  
Muhammad Abu Tailakh ◽  
Shlomo-yaron Ishay ◽  
Jenan Awesat ◽  
Liat Poupko ◽  
Gidon Sahar ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Hemoglobin A1c ◽  
Smoking Status ◽  
Artery Bypass ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Hba1c Levels

Objective: to estimate the association between preoperative hemoglobin A1c (HbA1c) levels below and above 7%, and the rate of all-cause mortality (ACM) in diabetes mellitus (DM) patients after coronary artery bypass grafting (CABG) within a ten-year follow-up period. Methods: we collected data on patient HbA1c levels that were measured up to 3 months prior to isolated CABG in consecutive patients with DM, and analyzed the rates of ACM over a median of a 5.9-year post-operative period. Results: preoperative HbA1c levels were collected in 579 DM patients. The mean HbA1c was 8.0 ± 1.7%, where 206 (35.6%) patients had an HbA1c ≤ 7% and 373 (64.4%) had an HbA1c > 7%. During the follow-up period, mortality rates were 20.4% and 28.7% in the HbA1c ≤ 7% and HbA1c > 7% groups, respectively (Kaplan-Meier estimates, log-rank p = 0.01). Multivariable Cox proportional hazards regression, adjusted for age, gender, smoking status, chronic obstructive pulmonary disease, hypertension, chronic renal failure, old myocardial infarction, number of coronary artery bypass surgeries, and post-operative glycemic control, showed a hazard ratio of 2.67 for long-term ACM (p = 0.001) in patients with HbA1c > 7%. Conclusions: DM patients with high HbA1c levels prior to CABG are at higher risk for long-term complications, especially late ACM.

scholarly journals Sleep apnea and diabetes mellitus are independently associated with cardiovascular events and hospitalization for heart failure after coronary artery bypass grafting

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Aye-Thandar Aung ◽  
Chieh-Yang Koo ◽  
Wilson W. Tam ◽  
Zhengfeng Chen ◽  
William Kristanto ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Coronary Artery ◽  
Sleep Apnea ◽  
Coronary Artery Bypass Grafting ◽  
Confidence Interval ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

AbstractThe relative and combined effects of sleep apnea with diabetes mellitus (DM) on cardiovascular outcomes in patients undergoing coronary artery bypass grafting (CABG) remain unknown. In this secondary analysis of data from the SABOT study, 1007 patients were reclassified into four groups based on their sleep apnea and DM statuses, yielding 295, 218, 278, and 216 patients in the sleep apnea (+) DM (+), sleep apnea (+) DM (−), sleep apnea (−) DM (+), and sleep apnea (−) DM (−) groups, respectively. After a mean follow-up period of 2.1 years, the crude incidence of major adverse cardiac and cerebrovascular event was 18% in the sleep apnea (+) DM (+), 11% in the sleep apnea (+) DM (−), 13% in the sleep apnea (−) DM (+), and 5% in the sleep apnea (−) DM (−) groups. Using sleep apnea (−) DM (−) as the reference group, a Cox regression analysis indicated that sleep apnea (+) and DM (+) independently predicted MACCEs (adjusted hazard ratio, 3.2; 95% confidence interval, 1.7–6.2; p = 0.005) and hospitalization for heart failure (adjusted hazard ratio, 12.6; 95% confidence interval, 3.0–52.3; p < 0.001). Sleep apnea and DM have independent effects on the prognosis of patients undergoing CABG.Clinical trial registration: ClinicalTrials.gov identification no. NCT02701504.

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