Preoperative Hemoglobin A1c Predicts Sternal Wound Infection after Coronary Artery Bypass Surgery with Bilateral versus Single Internal Thoracic Artery Grafts (original) (raw)
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Bangladesh Heart Journal
Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients. Objectives: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative ...
Journal of Cardiothoracic Surgery, 2021
Background Poor glycemic control has been associated with an increased risk of wound complications after various types of operations. However, it remains unclear how hemoglobin A1c (HbA1c) and preoperative glycemia can be used in clinical decision-making to prevent sternal wound complications (SWC) following off-pump coronary artery bypass grafting (OPCAB). Methods We conducted a retrospective study of 1774 consecutive patients who underwent OPCAB surgery between January 2010 and November 2016. A new four-grade classification for SWC was used. The associations of HbA1c and preoperative glycemia with incidence and grade of SWC were analysed using logistic regression analysis and proportional odds models, respectively. Results During a median follow-up of 326 days (interquartile range (IQR) 21–1261 days), SWC occurred in 133/1316 (10%) of non-diabetes and 82/458 (18%) of diabetes patients ( p < 0.001). Higher HbA1c was significantly associated with a higher incidence of SWC (odds ...
Erciyes Medical Journal, 2022
Objective: Diabetes mellitus (DM) is a very important prognostic factor in patients with coronary artery disease. The precise effects of controlled or uncontrolled diabetes on bypass graft patency in the long term have not yet been determined. The aim of this study was to assess the effect of the glycated hemoglobin (HbA1c) level on bypass graft patency and contribute information about HbA1c targets for patients with diabetes and a history of bypass surgery. Materials and Methods: A total of 606 patients who underwent coronary bypass surgery and coronary angiography were evaluated. Grafts with any stenosis not causing flow restriction were accepted as patent. The average of all available HbA1c measurements within a year of the angiography was used for analysis. Patients were also analyzed according to the average HbA1c level: well-controlled DM was defined as an average HbA1c level of <7% and uncontrolled DM was defined at an HbA1c level of ≥7%. Results: In all, 114 patients were included in the study, yielding a total of 289 grafts (venous: 182, arterial: 107). The median HbA1c value of the study population was 7.5 mg/dL. The occlusion rate of arterial and venous grafts was 12.4% and 28.2%, respectively. The median graft age was 8.0 years. The HbA1c level was similar in arterial and saphenous grafts according to the presence or absence of occlusion. Conclusion: The HbA1c level was not associated with long-term coronary bypass graft patency. Only a graft age of >5 years was significantly associated with long-term venous graft patency. Studies with patients whose HbA1c level is more strictly controlled may reveal different results.
International journal of surgery (London, England), 2018
Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes. Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry. The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs. 1.3%, a...
Pakistan Heart Journal, 2021
Objective: To determine the association of elevated HbA1c levels with length of ICU stay, prolonged mechanical ventilator and ionotropic support, and infections in diabetic patients undergoing CABG. Methodology: This Prospective cohort study was conducted at National Institute of Cardiovascular Diseases, Karachi. One hundred fifty eight (158) diabetic patients were enrolled fulfilling inclusion criteria. Data was classified into two groups, Exposed group: elevated HbA1c (≥7%) and Un-exposed group: HbA1c (<7%) and study outcomes in both groups were compared for any statistically significant difference. Results: Total 86.1% patients had prolonged ICU duration, 79.7% (p<0.001) had prolonged mechanical ventilator and 87.3% (p<0.001) patients with prolonged ionotropic support in Exposed group (elevated HbA1c). In Un-exposed group (controlled HbA1c), 44.3% patients had prolonged ICU duration, 12.7% patients had prolonged mechanical ventilator and 64.6% had prolonged ionotropic su...