Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry

Francesco Nicolini, Giuseppe Santarpino, Giuseppe Gatti, Daniel Reichart, Francesco Onorati, Giuseppe Faggian, Magnus Dalén, Sorosh Khodabandeh, Theodor Fischlein, Daniele Maselli, Saverio Nardella, Antonino S. Rubino, Marisa De Feo, Antonio Salsano, Riccardo Gherli, Giovanni Mariscalco, Eeva Maija Kinnunen, Vito G. Ruggieri, Karl Bounader, Matteo SaccocciSidney Chocron, Juhani Airaksinen, Andrea Perrotti, Fausto Biancari

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes. Material and methods: Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry. Results: The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs. 1.3%, adjusted p-value: 0.001) and acute kidney injury (27.4% vs. 19.8%, adjusted p-value: 0.042). These findings were confirmed in multilevel mixed effect logistic regression adjusted for participating centers. Among patients with diabetes, HbA1c ≥ 53 mmol/mol (7.0%) was predictive of SWI (11.1% vs. 4.8%, p = 0.001). Conclusions: HbA1c is increased in a significant proportion of patients undergoing elective CABG and these patients are at higher risk of SWI. Less clear is the impact of increased HbA1c on other postoperative outcomes. These results do not support screening of HbA1c in patients without history of diabetes. Preoperative screening of HbA1c is valuable only to identify diabetics at risk of SWI.

Original languageEnglish
Pages (from-to)354-359
Number of pages6
JournalInternational Journal of Surgery
Volume53
DOIs
Publication statusPublished - May 1 2018
Externally publishedYes

Keywords

  • CABG
  • Coronary artery bypass
  • Diabetes
  • Glycated hemoglobin
  • HbA1c

ASJC Scopus subject areas

  • Surgery

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