Excerpt

A retrospective cohort study conducted on 378 patients with a Risk Adjustment in Congenital Heart Surgery (RACHS-1) category ≥3 who underwent cardiac surgery in a single institution during the year 2003. Glucose control was determined by assessing the average, peak, minimum, and SD of glucose levels, and duration of hyperglycemia intraoperatively and for 72 h after surgery. Multivariable regression analyses were used to determine relationships between glucose control, hospital length of stay, and a composite morbidity-mortality outcome which include mortality, nosocomial infection, cardiovascular failure requiring extracorporeal membrane oxygenation, acute renal failure requiring dialysis, hepatic injury or new central nervous system injury. The results were adjusted for multiple variables that might influence early outcomes after congenital heart surgery such as age, prematurity, genetic syndrome, the presence of a major noncardiac structural anomaly, RACHS-1 category, CPB time, maximal inotrope score and the need for multiple procedures. The study did not show any association between intraoperative glucose variables and the duration of hospitalization, but a minimum glucose ≤75 mg/dl was associated with 3-fold greater adjusted odds of reaching the composite morbidity-mortality end point. Postoperatively, greater duration of glucose levels >126 mg/dl during the first 72 h after surgery was associated with longer hospital stay. Patients with average glucose levels <110 or >143 mg/dl, higher peak glucose levels, and lower minimum glucose levels all have greater adjusted odds for reaching the composite morbidity-mortality end point. …