Outcome of Tight Versus Standard Glycemic Control in Coronary Artery Bypass Patients

Abstract

Abstract

Objectives:  To compare the outcome of tight versus standard glycemic control and its impact on post oper-ative morbidity and short term mortality in patients undergoing Coronary Artery Bypass Grafting (CA-BG).

Patients and Methods:  A prospective surveillance of 124 patients undergoing isolated CABG surgery (on pump) was included in the study, 62 patients in each group were randomly assigned to tight and standard glucose control group. The main exposure was insulin in respect to level of blood glucose and the primary outcome measures were Sternotomy wound infection, Leg wound infection and new Myocardial Infarction. Surgical Site infection was assessed on a daily basis during the patient's stay in the Department of Cardio-thoracic Surgery, Sheikh Zayed Hospital, Lahore or within 30 days of operation prompting the patient to return to the hospital. Chi-square test or  test was used to identify the significance of various short term morbidities and mortality.

Results:  In this study, 12 patients in the standard group and 4 patients in the tightly controlled group developed Sternal wound infection (p value 0.046). Similarly, 9 versus 2 patients in the standard and tight group respectively developed Leg wound infection (p-value 0.035). Test of proportion was applied and it was found that there was significant difference in the pro-portion of infection in the two groups (p value 0.05). However, there were no significant differences in other morbidities and the short term mortality.

Conclusion:  Study confirmed that tight glucose con-trol post operatively in CABG patient's results in redu-ced sternal and leg wound infection rates; however, there was no effect on other morbidities and short term mortality.

Key words:  Glycemic control, Coronary artery by-pass grafting, Surgical Site Infections.