A study of HbA1c levels and outcome after cardiothoracic surgeries in the tertiary care hospitals

Abstract

Introduction : Previous clinical studies have reported that clinical outcomes after myocardial revascularization are significantly worse in diabetic patients than in non-diabetic patients. Only few studies have reported the impact of baseline HbA1c levels on outcomes for diabetic patients after CABG. This retrospective hospital data based  study therefore aimed to investigate whether preoperative HbA1c levels in diabetic patients are predictive of  outcomes after off-pump CABG. Methods: Retrospective, Comparative &  Analytical study. The data of inbound patients that required surgical operation was acquired from patients’ record Randomization was done using computer tables in selecting data. All patients were stratified into two groups, depending on their preoperative HbA1c, Group 1 with HBA1C level < 7%, and group 2 with level >7%. Intraoperative and postoperative adverse events were recorded from hospital data. Complications like arrhythmias, cerebrovascular accidents, bleeding, renal dysfunction, perioperative myocardial ischaemia, etc. were documented. The two groups of patients were analysed concerning their demographic data, surgical risk, mortality, and morbidity. Results: Number of patients with severe LV dysfunction / Reduced EF were considerably & significantly high in group of Raised HbA1c along with the number of Hypertensive, Diabetics  & Arrhythmias. The results of this study suggest that poor preoperative glycaemic control (HbA1C ≥7%) is a predictor of morbidity after CABG in terms of cardiac accidents, surgical site infections, need for dialysis, prolonged mechanical ventilation, prolonged hospital stay etc. Conclusion: In our opinion, preoperative HbA1c level is a strong predictor of morbidity after CABG. In elective situations, it has been proposed that these patients should be delayed for surgery until adequate glycaemic control is achieved. More prospective randomized long-term studies must be designed to study the adverse perioperative outcomes of diabetes in terms of preoperative HbA1c levels.