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Ann Thorac Surg 2009;87:663-669. doi:10.1016/j.athoracsur.2008.11.011
© 2009 The Society of Thoracic Surgeons
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Harold L. Lazar
Anthony P. Furnary
Richard M. Engelman
Charles R. Bridges
Constance K. Haan
Rolf Svedjeholm
Richard J. Shemin
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Report From STS Workforce on Evidence Based Surgery

The Society of Thoracic Surgeons Practice Guideline Series: Blood Glucose Management During Adult Cardiac Surgery

Harold L. Lazar, MDa,*, Marie McDonnell, MDb, Stuart R. Chipkin, MDc, Anthony P. Furnary, MDd, Richard M. Engelman, MDe, Archana R. Sadhu, MDf, Charles R. Bridges, MD, ScDg, Constance K. Haan, MD, MSh, Rolf Svedjeholm, MD, PhDi, Heinrich Taegtmeyer, MD, DPhilj, Richard J. Shemin, MDk

a Department of Cardiothoracic Surgery, the Boston Medical Center, Boston, Massachusetts
b Division of Endocrinology, the Boston Medical Center, Boston, Massachusetts
c The School of Public Health and Health Sciences, The University of Massachusetts, Amherst, Massachusetts
d The Starr-Wood Cardiac Group, Portland, Oregon
e The Baystate Medical Center, Springfield, Massachusetts
f Division of Endocrinology, Ronald Regan Medical Center, David Geffen School of Medicine, Los Angeles, California
g Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
h University of Florida College of Medicine, Jacksonville, Florida
i Department of Cardiothoracic Surgery, University Hospital, Linkoping, Sweden
j Division of Cardiology, The University of Texas School of Medicine, Houston, Texas
k The Division of Cardiothoracic Surgery, Ronald Regan Medical Center, David Geffen School of Medicine, Los Angeles, California

* Address correspondence to Dr Lazar, Department of Cardiothoracic Surgery, Boston Medical Center, 88 East Newton St, Boston, MA 02118 (Email: harold.lazar@bmc.org).

The first 300 words of the full text of this article appear below.


   Introduction
 
The prevalence of diabetes mellitus in patients requiring cardiac surgery is rapidly increasing. These patients have higher perioperative morbidity and mortality, significantly reduced long-term survival, and less freedom from recurrent episodes of angina [1–3]. There is now evidence to suggest that achieving glycemic control in patients with diabetes decreases perioperative morbidity and improves short-term and long-term survival.

Despite the emerging recognition of the importance of glycemic control, there are no specific guidelines for cardiac surgeons as to what the optimal level of glucose should be during the perioperative period, and the best method to achieve these target values. What follows is an executive summary of guidelines for the management of hyperglycemia in both patients with and without diabetes undergoing adult cardiac surgical procedures, derived from evidence-based recommendations (Table 1).


View this table:



  		Table 1 Classification System Used for Evidence Based Recommendations
 

   I. Detrimental Effects of Hyperglycemia in the Perioperative Period
 
Key Points: Poor Perioperative Glycemic Control is Associated With Increased Morbidity and Mortality
Doenst and coworkers [4] retrospectively reviewed the effects of hyperglycemia on the clinical outcomes of 6,280 patients undergoing cardiac surgical procedures. Higher glucose levels during surgery were found to be an independent predictor of mortality in patients with and without diabetes. Fish and coworkers [5] retrospectively reviewed the importance of blood glucose levels in the intraoperative and immediate postoperative period to predict morbidity in 200 consecutive coronary artery bypass graft (CABG) patients. A postoperative serum glucose level (> 250 mg/dL) was associated with a 10-fold increase in complications. Similar findings were reported by McAlister and coworkers [6] in a retrospective study of 291 patients undergoing CABG surgery. The average serum glucose level on the first postoperative day significantly predicted the development of an adverse outcome. The detrimental effects of elevated intraoperative glucose levels were also reported in a retrospective, observational study of 409 cardiac surgical patients by Gandhi and coworkers [7. . . [Full Text of this Article]




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