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Hypoglycemia after cardiac surgery increases risk for morbidity, mortality
Adults who undergo cardiac surgery who experience hypoglycemic episodes in the postoperative period have an increased risk for postoperative morbidity and long-term all-cause mortality, study data show.
“Close monitoring of patients receiving insulin postoperatively is needed to avoid hypoglycemia,” Mark E. Molitch, MD, of the division of endocrinology, metabolism and molecular medicine at Northwestern University Feinberg School of Medicine, told Endocrine Today. “Particular attention needs to be paid to those experiencing hypoglycemia so as to avoid additional episodes and to look for any underlying pathology that may contribute to both hypoglycemia and other potential adverse outcomes.”
Molitch and colleagues evaluated data on 1,325 adults who underwent cardiac surgery between September 2007 and April 2011 at Northwestern Memorial Hospital to determine differences in postoperative morbidity and mortality among adults who experience hypoglycemia after surgery and those who did not. Thirty-day and 5-year postoperative morbidity and mortality were analyzed. Overall, 215 participants experienced a hypoglycemic episode within 3 days after surgery; 32 experienced more than one episode on different days.
Compared with participants who did not experience a hypoglycemic episode, those who experienced a hypoglycemic episode were more likely to experience sepsis (P = .009), prolonged mechanical ventilation (P = .05), have renal failure (P = .027), require new postoperative dialysis (P < .001) and experience cardiac arrest (P = .01).
There was no significant difference in mortality HR between participants who experienced one hypoglycemic episode and those who experienced none. The mortality risk was significantly higher among participants who experienced more than one hypoglycemic episodes compared with those who did not experience any (HR = 1.96; 95% CI, 1.08-3.54).
Participants were also matched for propensity score to account for potential confounding for a subgroup of 198 participants who experienced hypoglycemic episodes and 363 participants who did not experience hypoglycemic episodes.
In this group, there were no significant short-term differences in morbidity, postoperative surgical complication rates or 30-day mortality between participants who experienced hypoglycemic episodes and those who did not. However, participants who experienced hypoglycemic episodes had higher long-term all-cause mortality compared with participants who did not experience hypoglycemic episodes.
“Hypoglycemia during intensive insulin management of hyperglycemic patients following surgery is common,” Molitch told Endocrine Today. “A single hypoglycemic episode is usually due to mismatch of insulin and carbohydrate intake and is not associated with adverse surgical outcomes. However, patients experiencing two or more episodes of hypoglycemia did have an increase in adverse outcomes, including a small increase in long-term mortality. It may well be that those experiencing two or more hypoglycemic episodes may have additional underlying pathology that may also contribute to postoperative morbidity and mortality.” – by Amber Cox
For more information:
Mark E. Molitch , MD, can be reached at molitch@northwestern.edu.
Disclosure: Molitch reports various financial ties with AstraZeneca, Bayer, Janssen, Merck, Novartis, Novo Nordisk and Pfizer.