The Effectiveness of Tight Glycemic Control on Reducing Surgical Site Infection in Diabetic Patients Undergoing Coronary Artery Bypass Grafting

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Date
2021-05-06
Authors
بلاصي, بلال
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An-Najah National University
Abstract
Introduction: mellitus is associated with increased surgical morbidity and mortality. The relatively high risk may be related to the level of perioperative hyperglycemia. Glycemic control in postoperative cardiac patients is necessary to improve the outcome of wound infection and overall mortality. In recent years, clinical trials that evaluated blood glucose control in critically ill patients for intensive blood glucose management and found a significant reduction in morbidity and mortality. Some organizations have published recommendations for the management of blood glucose in critically ill patients that reflect this information. However, new clinical trials evaluating blood glucose target areas in critically ill patients have found conflicting results, leading to a reassessment of current targets and guidelines, enabling less strict blood sugar target areas. With the inconsistency in clinical trials evaluating a target blood glucose range for critically ill patients, especially postoperative cardiac surgery patients, target blood sugar is still not clearly defined. Further comparisons of specific glucose ranges would allow a clearer definition of recommended blood glucose targets for postoperative cardiac patients. Aim: The aim of this study is to evaluate the efficacy of tight glycemic control interventions intraoperative and postoperative with a continuous insulin infusion to maintain blood glucose levels of 150-180 mg/dl to reduce the complications of open heart surgery, ie. readmission, hospital mortality, length of stay, hospital stay, incidence of hypoglycemic events (blood glucose levels ≤70 mg/dl) in adult diabetic patients undergoing CABG. Material and method: A quasi-experimental study conducted among diabetic patients undergoing elective CABG. Single-center clinical trial conducted among diabetic patients, male 86 and female 14, aged 18-70 years with ASA II- III undergoing CABG from AL-Ahli Hospital, Hebron- Palestine. Patients are divided into experimental group (E group) modified tight control (Blood Sugar maintained between 150-180 mg/dl) and ahistorical Control Group (C Group) received sliding-scale insulin to maintain blood glucose). Patients were followed up to 48 hours postoperatively. Incidence of surgical site infections, readmission, in-hospital mortality, length of ICU stay, length of hospital stay, incidence of hypoglycemic events (blood sugar levels ≤70 mg/dl), and another complications in adult diabetic patients undergoing CABG were collected. Results: There are no significant differences between the historical group and the experimental group in gender, age, weight, high, and BMI (P-values>0.05). The results exhibited that there were no significant difference in the mean of preoperative blood glucose in the historical group M± SD(185.22±38.76) compared to the experimental group173.72±18.74 (p= 0.063). At the opposite of this result, the results exhibited that the mean of hemoglobin A1c in the historical group (mean=9.12) is significantly lower than that in the experimental group (mean=9.71) (p=0.003). The results exhibited that the mean of intraoperative blood glucose in the historical group M± SD (223.03±47.32) is significantly higher than that in the experimental group M± SD (170.91±2.64) (p=0.000). The results exhibited also that the mean of postoperative blood glucose in the historical group (mean=283.08) is significantly higher than that in the experimental group (mean=168.88) (p=0.000). The results exhibited that the number of patients who had deep sternal infection in the historical group (N (%) =4(8%)) is significantly higher than that in the experimental group (N(%)=0(0%)) (p= 0.041). Also the results exhibited that the number of patients who had pneumonia in the historical group (N(%)=4(8%)) is significantly higher than that in the experimental group (N (%)=0(0%)) (p= 0.041). Also the results exhibited that the number of patients who had stroke in the historical group(N(%)=4(8.2%)) is significantly higher than that in the experimental group(N(%)=0(0%)) (p=0.039) . The results exhibited that the mean of ICU-LOS (days)in the historical group (mean=4.14) is significantly higher than that in the experimental group (mean=2.18) (p=0.000). Also, the results exhibited that the mean of postoperative hospital LOS (days) in the historical group (mean=5.72) is significantly higher than that in the experimental group (mean=4.98) (p=0.000). Conclusion : Maintaining blood glucose levels (150-180) with continuous insulin infusion at all stages of the perioperative period will minimize the incidence of surgical site infection, episodes of hypoglycemia, stroke, pneumonia and length of stay in ICU and hospital in patients undergoing CABG surgery.
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