Evaluation Of Glycemic Variabilities During Cardiopulmonary Bypass And Post-Op Complications

Abstract

Background: Cardiopulmonary bypass (CPB) in a heart operation causes a severe metabolic stress, which brings about glucose homeostasis imbalances. These changes are referred to as glycemic variability and occur as a result of hypothermia, hemodilution, release of stress hormones and have also been linked to poor postoperative events such as infections, neurological events, and extended hospitalization period.

Objective To assess the intraoperative changes in glycemia during cardiopulmonary bypass and whether these changes are related to post-operative complication in patients undergoing cardiac surgery

Methodology The study was a prospective observational study that was undertaken on 323 adult patients undergoing elective cardiac surgery using CPB in tertiary care hospitals. Non-probability consecutive sampling was used. The level of blood glucose was checked at fixed CPB phases (pre, during and post-CPB). The information on demographic variables, intraoperative and postoperative outcomes were gathered. The statistical analysis was done using SPSS version 27.0 with descriptive statistics, repeated measures ANOVA, Pearson correlation and multivariate regression analysis with a p value of 0.05 level of significance

Results The average age of the study participant was 58.30 +- 10.20 years old and equal proportion of diabetic and non-diabetic patients was used. Notable changes in glycemia were noted in CPB especially in diabetic patients. Glycemic variability was significantly positively correlated with the postoperative complications such as atrial fibrillation, stroke, acute kidney injury, surgical site infections, and mortality and did not have a significant relationship with reoperation. In multivariate analysis, diabetes mellitus was found to be an independent predictor of adverse outcome, but age and duration of CPB were insignificant predictors.

Conclusion Glycemic variability in CPB is an important predictor of postoperative complications among cardiac surgery patients. The high risk is especially in diabetic patients as there are more glucose fluctuations. It is important that effective intraoperative glucose monitoring and specific glycemic control interventions are built in order to reduce complications and enhance the outcome of surgery.