Study questions the relevance of benchmarks among CABG patients receiving insulin infusions
Cardiothoracic surgeons and endocrinologists from Boston Medical Center (BMC) have found that among patients undergoing coronary artery bypass graft (CABG) surgery, achieving Surgical Care Improvement Project (SCIP) benchmarks for glycemic control may be irrelevant when perioperative continuous insulin infusion protocols are implemented.
Currently, 40 percent of all patients undergoing CABG suffer from diabetes, and this number is quickly rising. Traditionally these patients have more complications following surgery, including greater risk of heart attacks, more wound infections and reduced long-term survival. Previous studies from BMC have shown that patients receiving insulin infusions during surgery and in the postoperative period to achieve blood glucose levels of less than 200mg/dl have significantly less morbidity and mortality. As a result of these pioneering studies, national guidelines now mandate that all CABG patients receive an intravenous insulin infusion when necessary to maintain blood glucose levels of less than 200mg/dl in the perioperative period.
SCIP has benchmarked 6 a.m. blood glucose of less than 200 mg/dl on post-operative day one and day two as a quality measure of glycemic control in cardiac surgery to be used for reporting of operative outcomes and monetary reimbursement. However, the relevance of SCIP in patients already receiving continuous insulin infusions, designed to achieve optimal glycemic control, is unknown. Hospitals in which SCIP outliers are present may be publicly cited for poor glycemic control and receive less monetary reimbursement. It is important, therefore, to determine whether SCIP is a valid marker of glycemic control in CABG patients.
Between January 2006 and April 2011, 833 patients underwent CABG surgery at BMC and received continuous insulin infusions to maintain serum blood glucose of less than 180 mg/dl. Patients were divided into two groups: patients compliant with SCIP and those who were outliers-those who fell outside of the SCIP guidelines.
The researchers found the incidence of SCIP outliers to be 6.6 percent. These patients were more likely to suffer from insulin-dependent diabetes, have a higher hemoglobin A1c level which is indicative of poor glucose control in the months preceeding surgery, higher body mass and lower ejection fraction. "However, patients who were SCIP outliers had no increase in morbidity, mortality or hospital length of stay," explained senior author Harold Lazar, MD, a cardiothoracic surgeon at BMC and professor of cardiothoracic surgery at Boston University School of Medicine.
According to Lazar these findings may have national implications and may result in changes in guidelines for glycemic control. "We found that these patients may have had excellent glycemic control except for that one 6AM glucose level," added Lazar. A better index of glycemic control is to look at the percentage of time that a patients' glucose was less than 200mg/dl over 48 hours and not just one or two arbitrary points in time. "On the other hand, we saw patients who had poor glycemic control but just happened to have a glucose level of less than 200mg/dl at the two time periods measured by SCIP."
Furthermore, this study had identified groups of patients whose glucose levels are harder to control despite the fact that are continuously receiving insulin. Yet, they are still better off compared to not having received any infusions----however, they would be considered SCIP outliers and those hospitals would be penalized. "We think that glycemic control is important in ALL CABG patients----however, current SCIP guidelines are not an accurate method to determine whether hospitals are truly compliant with meeting the goals of glycemic control."
These findings were presented at the Annual meeting of the American Association for Thoracic Surgery on May 1 in San Francisco, CA.
Provided by Boston University Medical Center
- Study finds aggressive glycemic control in diabetic cabg patients does not improve survival Sep 27, 2011 | not rated yet | 0
- Study finds aggressive glycemic control in diabetic CABG patients does not improve survival Apr 14, 2011 | not rated yet | 0
- Experts suggest all hospitalized patients have blood glucose levels tested Jan 05, 2012 | not rated yet | 0
- Intensive insulin therapy may be harmful to the critically ill Feb 29, 2008 | not rated yet | 0
- Study suggests drug significantly improves glycemic control in type one diabetics on insulin Jun 15, 2011 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
question on coriolis effect with drag force
6 hours ago I really need help with this question. A small floating object initially moves with velocity v on the surface of a liquid at latitude λ. The...
Question of reflection and transmission of TEM wave in normal incidenc
12 hours ago Suppose TEM wave in +z normal to a boundary on xy plane at z=0. We know *E* & *H* are tangential to the boundary. Let ##\vec E_i=\hat x E##, be the...
the rudyak-krasnolutski effective potencial
13 hours ago Hi ... anyone now how to calculate or the formula of the rudyak-krasnolutski EFFECTIVE potencial ? the effective potencial includes the angular...
Normal force for a lever model
14 hours ago My model is a lever on a table top. One arm is horizontal on the table, while the other arm is raised at an angle alpha. I'm assuming the weight of...
gravity is std. therefore can we rate a 'mass at height' by watts?
19 hours ago For example.... wind turbines are primarily listed by their wattage (1.5MW etc.) Presumably their output is varied according to rotational speed, so...
Calculating on-axis elements of a solenoid
May 22, 2013 I wanted to mention that this solenoid has many winds over many layers. The thickness of the windings is 2.4 inches coming off of the engineering...
- More from Physics Forums - Classical Physics
More news stories
(HealthDay)—In patients who have previously been considered difficult to image, dual-source cardiac (DSC) computed tomography (CT) can identify clinically significant coronary artery disease, according ...
Cardiology 10 hours ago | not rated yet | 0
UCLA researchers examining outcomes for advanced heart-failure patients over the past two decades have found that, coinciding with the increased availability and use of new therapies, overall mortality has decreased and sudden ...
Cardiology 13 hours ago | not rated yet | 0
22 May 2013, Paris, France: The Lotus Valve, a second-generation transcatheter aortic valve implantation (TAVI) device, was successfully implanted in all of the first 60 patients in results from REPRISE II reported at EuroPCR ...
Cardiology 17 hours ago | not rated yet | 0
Costs to treat stroke are projected to more than double and the number of people having strokes may increase 20 percent by 2030, according to the American Heart Association/American Stroke Association.
Cardiology May 22, 2013 | not rated yet | 0
Blood thinners are the preferred treatment option to prevent heart attacks, blood clots and stroke, but they are not without risk, and not just because of their side effects. These high-risk drugs, known as anticoagulants, ...
Cardiology May 22, 2013 | not rated yet | 0
The British Menopause Society and Women's Health Concern have today released updated guidelines on Hormone Replacement Therapy (HRT) to provide clarity around the role of HRT, the benefits and the risks. The new guidelines ...
13 minutes ago | not rated yet | 0
(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...
11 hours ago | 4.8 / 5 (6) | 0 |
A brief visual task can predict IQ, according to a new study. This surprisingly simple exercise measures the brain's unconscious ability to filter out visual movement. The study shows that individuals whose ...
16 hours ago | 4.5 / 5 (10) | 1 |
Teams of highly respected Alzheimer's researchers failed to replicate what appeared to be breakthrough results for the treatment of this brain disease when they were published last year in the journal Science.
14 hours ago | 5 / 5 (1) | 2 |
Scientists at the National Institutes of Health report they have discovered in mouse studies that a small molecule released in the spinal cord triggers a process that is later experienced in the brain as ...
14 hours ago | 5 / 5 (2) | 0 |
Little is known about why asthma develops, how it constricts the airway or why response to treatments varies between patients. Now, a team of researchers at Weill Cornell Medical College, Columbia University Medical Center ...
15 hours ago | not rated yet | 0 |