Association between HbA1c levels and clinical outcomes in patients undergoing isolated coronary artery bypass grafting

Öz

Purpose: Several studies have indicated that elevated HbA1c levels may increase adverse postoperative outcomes in cardiac surgery. However, the consistency of this relationship remains unclear. This study aimed to evaluate the impact of preoperative HbA1c levels on postoperative clinical outcomes in patients undergoing isolated coronary artery bypass grafting (CABG). Materials and methods: A total of 169 patients who underwent elective, primary, isolated CABG under cardiopulmonary bypass (CPB) between January 2022 and January 2024 were retrospectively analyzed. Patients were divided into three groups based on their preoperative HbA1c levels: Group I (<5%), Group II (5-6.5%), and Group III (>6.5%). Demographic characteristics, preoperative risk factors, operative details, and postoperative complications were recorded. Logistic regression analysis was used to assess the relationship between HbA1c levels and postoperative outcomes such as atrial fibrillation, sternal wound infection, and chest tube drainage. Results: The prevalence of diabetes mellitus (82.1%) and peripheral arterial disease (32.8%) was significantly higher in Group III (p<0.05). Postoperative complications, including sternal wound infection (p=0.036), atrial fibrillation (p=0.006), and higher 24-hour drainage volume (p=0.01), were more frequent in this group. HbA1c >6.5% was an independent predictor of sternal wound infection (OR:3.81; 95% CI:1.25-11.5) and atrial fibrillation (OR:2.25; 95% CI:1.17-4.32). Additionally, HbA1c positively correlated with drainage volume (r=0.172, p=0.026) and erythrocyte suspension usage (r=0.201, p=0.01). Conclusion: High preoperative HbA1c levels are associated with increased risk of postoperative complications. HbA1c may serve as a valuable predictor of adverse outcomes, and optimizing glycemic control before surgery could improve prognosis.

Anahtar Kelimeler

• CABG
• HbA1c
• complications

İzole koroner arter bypass cerrahisi uygulanan hastalarda HbAIC düzeyleri ile klinik sonuçlar arasındaki ilişki

Öz

Amaç: Bazı çalışmalar, yüksek HbA1c düzeylerinin kalp cerrahisi sonrası olumsuz postoperatif sonuçları artırabileceğini göstermiştir. Ancak, HbA1c düzeyleri ile klinik sonuçlar arasındaki ilişki halen net değildir. Bu çalışmada, izole koroner arter bypass greftleme (CABG) uygulanan hastalarda preoperatif HbA1c düzeylerinin postoperatif klinik sonuçlar üzerindeki etkisinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Ocak 2022 - Ocak 2024 tarihleri arasında kardiyopulmoner bypass (KPB) altında elektif, primer, izole CABG uygulanan 169 hasta retrospektif olarak analiz edildi. Hastalar preoperatif HbA1c düzeylerine göre üç gruba ayrıldı: Grup I (<%5), Grup II (%5-6,5) ve Grup III (>%6,5). Demografik veriler, preoperatif risk faktörleri, cerrahi ayrıntılar ve postoperatif komplikasyonlar kaydedildi. HbA1c düzeyleri ile atriyal fibrilasyon, sternal yara enfeksiyonu ve drenaj gibi postoperatif komplikasyonlar arasındaki ilişki lojistik regresyon ile değerlendirildi. Bulgular: Diyabet (%82,1) ve periferik arter hastalığı (%32,8) Grup III’te anlamlı olarak daha yüksekti (p<0,05). Sternal yara enfeksiyonu (p=0,036), atriyal fibrilasyon (p=0,006) ve 24 saatlik drenaj miktarı (p=0,01) Grup III’te daha fazlaydı. HbA1c >%6,5, sternal enfeksiyon (OR:3,81) ve atriyal fibrilasyon (OR:2,25) için bağımsız risk faktörüydü. Ayrıca HbA1c, drenaj (r=0,172, p=0,026) ve eritrosit süspansiyonu kullanımı (r=0,201, p=0,01) ile pozitif korelasyon gösterdi. Sonuç: Yüksek preoperatif HbA1c düzeyleri, postoperatif komplikasyon riskinin artmasıyla ilişkilidir. HbA1c, olumsuz sonuçların değerli bir öngörücüsü olabilir ve ameliyat öncesi glisemik kontrolün optimize edilmesi prognozu iyileştirebilir.

Anahtar Kelimeler

• CABG
• HbA1c
• komplikasyonlar

Kaynakça

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