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Is pre-operative haemoglobin A1c level a successful predictor of adverse outcome after cardiac surgery?

  • Ai Hooe Tee
  • R Hasan
  • KE Mclaughlin
  • DJM Keenan
  • S Datta
Open Access
Meeting abstract

Keywords

Cardiac Surgery Uncontrolled Diabetes Undiagnosed Diabetes Successful Predictor Urgent Case 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background/Introduction

Uncontrolled diabetes mellitus increases morbidity and mortality after cardiac surgery. Haemoglobin A1c (Hb A1c) is used to measure long-term glucose control. There have been reports of a higher incidence of wound infections with uncontrolled Hb A1c levels in patients undergoing cardiac surgery.

Aims/Objectives

To establish clinical significance of elevated HbA1c level among patients who underwent cardiac surgery, and whether this may influence their postoperative mortality and morbidity.

Method

We performed a retrospective review of patients who underwent cardiac surgery over a 4-year period (2012-2015). Patients were stratified into three HbA1c groups (I = HbA1c 20-41 mmol/mol; II = HbA1c 42-48 mmol/mol; III = HbA1c 49-150 mmol/mol). Study end points were post-operative wound infection, stroke and renal failure. Chi-square test and independent sample t-test were performed to compare variables of interest.

Results

Among 1452 patients, 883 patients were in group I, 281 in group II and 288 in group III. There was statistically significant difference in post-operative wound infections between three groups (p < 0.006), with Group III having the highest rate of 7.6% while Group II 6.8% and Group I 3.5%. Patients with pre-operative HbA1c>42 mmol/mol (7.2% vs 3.5%) had a higher incidence of post-operative wound infections (p < 0.002; OR 2.134; 95% CI 1.322 - 3.445) when compared with Hb1Ac <42 mmol/mol. Patients with pre-operative HbA1c>;42 mmol/mol also had a significant increase in post-operative renal complications (p-value < 0.033; OR 2.569; 95%CI 1.049 - 6.290). Sub-group analysis among the urgent cases (n = 333) showed a 2.1 fold rise in wound infection (p < 0.02, OR 21, 95% CI 1.3-2.7). There was no statistical rise in incidence of stroke or mortality between the groups.

Discussion/Conclusion

Elevated Hb1Ac was associated with increased wound infections and risk of renal dysfunction after cardiac surgery. Patients undergoing urgent surgery with undiagnosed diabetes may remain at increased risk of post-operative wound infections.

Copyright information

© Tee et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Ai Hooe Tee
    • 1
  • R Hasan
    • 2
  • KE Mclaughlin
    • 2
  • DJM Keenan
    • 2
  • S Datta
    • 2
  1. 1.School of MedicineUniversity of ManchesterManchesterUK
  2. 2.Department of Cardiac SurgeryManchester Royal InfirmaryManchesterUK

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