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
-
Equating differentials => equating coefficients
1 hour ago
-
The idea behind a reverse shock
7 hours ago
-
Guass's Law for a charge distribution
7 hours ago
-
Noise dependence
8 hours ago
-
siphon and bernouli theorum
9 hours ago
-
Hot gas expansion rate into outer space
10 hours ago
- More from Physics Forums - Classical Physics
More news stories
Heart failure accelerates male 'menopause'
Heart failure accelerates the aging process and brings on early andropausal syndrome (AS), according to research presented today at the Heart Failure Congress 2013. AS, also referred to as male 'menopause', was four times ...
Cardiology
12 hours ago |
not rated yet |
1
Death highest in heart failure patients admitted in January, on Friday, and overnight
Mortality and length of stay are highest in heart failure patients admitted in January, on Friday, and overnight, according to research presented today at the Heart Failure Congress 2013. The analysis of nearly 1 million ...
Cardiology
13 hours ago |
not rated yet |
0
First drug to improve heart failure mortality in over a decade
Coenzyme Q10 decreases all cause mortality by half, according to the results of a multicentre randomised double blind trial presented today at Heart Failure 2013 congress. It is the first drug to improve heart failure mortality ...
Cardiology
13 hours ago |
5 / 5 (2) |
5
Registry confirms TAVI efficacy and safety in Asian patients
Transcatheter aortic valve implantation (TAVI) is effective and safe in Asian patients, according to early experience based on first results from a multicentre Asian registry reported at EuroPCR 2013.
Cardiology
May 24, 2013 |
not rated yet |
0
Diagnostic coronary angiography: Functional flow reserve changes decisions in 25 percent of cases
Routinely measuring fractional flow reserve (FFR) using pressure wire assessment during coronary angiography for diagnosis of chest pain leads to significant changes in the management of one in four patients, according to ...
Cardiology
May 24, 2013 |
not rated yet |
0
Seniors more likely to crash when driving with pet, study finds
(HealthDay)—Animals make great companions for senior citizens, but elderly people who always drive with a pet in the car are far more likely to crash than those who never drive with a pet, researchers have ...
Feds fight morning-after pill age ruling in NY
(AP)—Department of Justice lawyers have again asked a federal appeals court in New York to delay lifting age restrictions and prescription requirements on an emergency contraceptive popularly known as the morning-after ...
New immune system discovered
(Medical Xpress)—A research team, led by Jeremy Barr, a biology post-doctoral fellow, unveils a new immune system that protects humans and animals from infection.
Brain can be trained in compassion, study shows
Until now, little was scientifically known about the human potential to cultivate compassion—the emotional state of caring for people who are suffering in a way that motivates altruistic behavior.
Hormone levels may provide key to understanding psychological disorders in women
Women at a particular stage in their monthly menstrual cycle may be more vulnerable to some of the psychological side-effects associated with stressful experiences, according to a study from UCL.
Do salamanders hold the solution to regeneration?
Salamanders' immune systems are key to their remarkable ability to regrow limbs, and could also underpin their ability to regenerate spinal cords, brain tissue and even parts of their hearts, scientists have ...