Predictability of Preoperative Hemoglobin A1c in Diabetic Patients Underwent Off-Pump Coronary Artery Bypass Surgery: A Retrospective Study.

Brief Summary: The aim of this study is to evaluate evaluated the impact of preoperative HbA1c in diabetic patients on perioperative glycemic variability and outcome after off-pump coronary artery bypass (OPCAB).

The medical records of patients who had a preoperative diagnosis of diabetes and underwent OPCAB from 2005 to 2017 will be reviewed. Patients are divided by HbA1c levels (\<7.0% or ≥7.0%). Glycemic variability during surgery and up to 24 hours after surgery is assessed by the coefficient of variation. The primary outcome is defined as a composite of postoperative permanent stroke, prolonged ventilation, deep sternal wound infection, renal failure, reoperation, mortality according to the definition of STS (Society of Thoracic Surgery) version 2.81 adult cardiac surgery database. If one or more of the above five morbidity or mortality occur, it is assumed that composite morbidity/mortality had occurred. We compare postoperative complications, mortality and perioperative glycemic variability between patients with HbA1c ≥7.0% and \<7.0%, and examined the effects of perioperative glycemic control on postoperative morbidity and mortality (composite morbidity/mortality).

Recruitment & Eligibility

Inclusion Criteria

Patients with a history of preoperative diabetes mellitus and with available results of HbA1c test within 3 months before surgery.
Patients who aged 20 to 89 years

Exclusion Criteria

Primary Outcome Measures

Name	Time	Method
Incidence of Deep sternal wound infection	during the hospitalization for surgery (up to 30 days)	Deep sternal wound infection or mediastinitis including muscle layer according to CDC definition
Incidence of Renal failure	during the hospitalization for surgery (up to 30 days)	1. Increase in serum creatinine level 3.0 x greater than baseline, or serum creatinine level ≥ 4 mg/dL. The acute rise must be at least 0.5 mg/dl. 2. A new requirement for dialysis postoperatively.
Incidence of Permanent stroke	during the hospitalization for surgery (up to 30 days)	postoperative stroke (i.e., any confirmed neurological deficit of abrupt onset caused by a disturbance in blood supply to the brain that did not resolve within 24 hours.)
Incidence of Prolonged ventilation	during the hospitalization for surgery (up to 30 days)	Prolonged post-operative pulmonary ventilation \> 24.0 hours. The hours of postoperative ventilation time include OR exit until extubation, plus any additional hours following reintubation.
Incidence of Re-operation for any reason	during the hospitalization for surgery (up to 30 days)	reoperation for bleeding/tamponade, valvular dysfunction, graft occlusion, other cardiac reason, or non-cardiac reason
Operative mortality	during the hospitalization for surgery (up to 30 days)	all deaths, regardless of cause

Secondary Outcome Measures

Name	Time	Method
Perioperative Coefficient of variation of glucose	During surgery and up to the first 24 hours after surgery	the standard deviation divided by the average of blood glucose concentration during surgery and first 24 hours after surgery
Perioperative time-weighted average glucose	During surgery and up to the first 24 hours after surgery	time-weighted average of blood glucose concentration during surgery and first 24 hours after surgery
Incidence of Perioperative Coefficient of variation of glucose	During surgery and up to the first 24 hours after surgery	the standard deviation of blood glucose concentration during surgery and first 24 hours after surgery
Perioperative mean glucose	During surgery and up to the first 24 hours after surgery	average of blood glucose concentration during surgery and first 24 hours after surgery

Locations (1): Department of Anesthesiology & Pain Medicine, Yonsei university college of medicine
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Seoul, Korea, Republic of