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ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 37 (04) • 2022 • https://doi.org/10.21470/1678-9741-2020-0542 linkcopy

The Importance of HbA1c and Left Ventricular Ejection Fraction in Predicting the Development of Postoperative Mortality and Complications in Coronary Artery Bypass Graft Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction: In this study, we aimed to investigate the relationship between postoperative mortality, morbidity, hospital stay and development of postoperative complications with the glycosylated hemoglobin (HbA1c) level and low left ventricular ejection fraction (LVEF) in diabetic and non-diabetic patients who underwent elective coronary artery bypass (CABG) surgery.

Methods: The medical records of patients who underwent CABG at our clinic between January 2015 and December 2019 were retrospectively analyzed. All patients were divided into two groups according to their diabetes mellitus (DM) diagnosis. Diabetic patients were also divided into two groups according to their HbA1c levels. The HbA1c threshold value was 7%. All patients were divided into two groups in terms of LVEF. The LVEF threshold value was 40%.

Results: We analyzed 393 patients, of which 304 (77.4%) were male and 177 (45.04%) patients were diabetic. For lower LVEF and HbA1c values, we found no relationship between postoperative mortality, prolonged intensive care unit (ICU) stay and development of postoperative complications. Deep surgical site infection (DSSI) was found to be more common in diabetic patients who had a higher HbA1c value. Length of hospital stay was longer in diabetic patients with HbA1c levels <7%.

Conclusion: No statistically significant relationship was found between LVEF and HbA1c levels and postoperative mortality, prolonged ICU stay and postoperative complications.

Keywords: Coronary Artery Bypass Grafts; CABG; Hba1c; Diabetes Mellitus; Surgery; Complications.

Abbreviations, acronyms & symbols
AF	= Atrial fibrillation		DSSI	= Deep surgical site infection
AKI	= Acute kidney injury		DSSI	= Deep surgical site infection
AMI	= Acute myocardial infarction		EF	= Ejection fraction
BSA	= Body surface area		HbA1c	= Glycosylated hemoglobin
CABG	= Coronary artery bypass graft		HF	= Heart failure
CAD	= Carotid artery disease		ICU	= Intensive care unit
COPD	= Chronic obstructive pulmonary disease		LIMA	= Left internal mammary artery
CPB	= Cardiopulmonary bypass		LVEF	= Left ventricular ejection fraction
CKD	= Chronic kidney disease		LV	= Left ventricle
CVD	= Cerebrovascular disease		PCI	= Percutaneous coronary intervention
DM	= Diabetes mellitus		XCL	= Cross-clamp

	Diabetic (n=216)	Non-diabetic (n=177)	Comparison
HbA1c	5.59±0.232	8.142±1.938*	Z=16.897
HbA1c	5.59±0.232	8.142±1.938*	P<0.001
XCL time	64.07±26.511	61.05±22.871	Z=1.223
XCL time	64.07±26.511	61.05±22.871	P=0.221
CPB time	130.99±50.282	121,940±43.236	Z=0.587
CPB time	130.99±50.282	121,940±43.236	P=0.112
ICU stay	5.42±5.27	6.40±7.40	Z=0.568
ICU stay	5.42±5.27	6.40±7.40	P=0.570
Length of hospital stay	13±8.749	13.898±9.642	Z=0.511
Length of hospital stay	13±8.749	13.898±9.642	P=0.609
Mortality (n=69, 17.6%)	30 (16.9%)	39 (18.1%)	χ²=0.082
Mortality (n=69, 17.6%)	30 (16.9%)	39 (18.1%)	P=0.774
Postoperative CVD (n=7, 1.8%)	3 (1.4%)	4 (2.3%)	χ²=0.432
Postoperative CVD (n=7, 1.8%)	3 (1.4%)	4 (2.3%)	P=0.511
Postoperative AF (n=117, 29.8%)	54 (30.7%)	63 (29.2%)	χ²=0.106
Postoperative AF (n=117, 29.8%)	54 (30.7%)	63 (29.2%)	P=0.744
Postoperative AKI (n=51, 13%)	26 (12%)	25 (14.2%)	χ²=0.403
Postoperative AKI (n=51, 13%)	26 (12%)	25 (14.2%)	P=0.526
DSSI (n=6, 5.8%)	0	6 (10.5%)*	χ²=5.142
DSSI (n=6, 5.8%)	0	6 (10.5%)*	P=0.0.23

	EF <40 (n=48)	EF >40 (n=345)	Comparison
LVEF	37.67±3.191	53.47±5.268	Z=11.386
LVEF	37.67±3.191	53.47±5.268	P<0.001
ICU stay	4.833±4.710	6.012±6.517	Z=1.082
ICU stay	4.833±4.710	6.012±6.517	P=0.279
Length of hospital stay	11.625±7.468	13.658±9.355	Z=1.277
Length of hospital stay	11.625±7.468	13.658±9.355	P=0.202
Mortality (n=69)	9 (18.8%)	60 (17.4%)	χ²=0.054
Mortality (n=69)	9 (18.8%)	60 (17.4%)	P=0.817
Postoperative CVD (n=7)	2 (4.2%)	5 (1.5%)	χ²=1.768
Postoperative CVD (n=7)	2 (4.2%)	5 (1.5%)	P=0.184
Postoperative AF (n=117)	18 (37.5%)	99 (28.8%)	χ²=1.530
Postoperative AF (n=117)	18 (37.5%)	99 (28.8%)	P=0.216
Postoperative AKI (n=51)	10 (20.8%)	41 (11.9%)	χ²=2.958
Postoperative AKI (n=51)	10 (20.8%)	41 (11.9%)	P=0.085
DSSI (n=6)	0	6 (6.7%)*	χ²=0.920
DSSI (n=6)	0	6 (6.7%)*	P=0.337

	HbA1c <7% (n=271)	HbA1c >7% (n=122)	Comparison
HbA1c	5.753±0.420	8.935±1.831*	Z=15.930
HbA1c	5.753±0.420	8.935±1.831*	P<0.001
ICU stay	5.723±5.988	6.189±7.049	Z=0.475
ICU stay	5.723±5.988	6.189±7.049	P=0.634
Length of hospital stay	13.413±8.825	13.402±9.904	Z=1.132
Length of hospital stay	13.413±8.825	13.402±9.904	P=0.258
Mortality (n=69)	49 (18.1%)	20 (16.4%)	χ²=0.166
Mortality (n=69)	49 (18.1%)	20 (16.4%)	P=0.684
Postoperative CVD (n=7)	4 (1.5%)	3 (2.5%)	χ²=0.458
Postoperative CVD (n=7)	4 (1.5%)	3 (2.5%)	P=0.499
Postoperative AF (n=117)	82 (30.4%)	35 (28.7%)	χ²=0.114
Postoperative AF (n=117)	82 (30.4%)	35 (28.7%)	P=0.736
Postoperative AKI (n=51)	35 (12.9%)	16 (13.2%)	χ²=0.007
Postoperative AKI (n=51)	35 (12.9%)	16 (13.2%)	P=0.933
DSSI (n=6)	0	6 (13.6%)*	χ²=8.543
DSSI (n=6)	0	6 (13.6%)*	P=0.003

	Diabetic patients HbA1c <7 (n=55)	Diabetic patients HbA1c >7 (n=122)	Comparison
HbA1c	6.382±0.401	8.935±1.938*	Z=10.649
HbA1c	6.382±0.401	8.935±1.938*	P<0.001
XCL time	55.16±21.09	63.70±23.22*	Z=2.315
XCL time	55.16±21.09	63.70±23.22*	P=0.021
CPB time	112.42±39.43	126.24±44.33*	Z=1.963
CPB time	112.42±39.43	126.24±44.33*	P=0.05
ICU stay	6.89±8.17	6.18±7.04	Z=0.045
ICU stay	6.89±8.17	6.18±7.04	P=0.964
Length of hospital stay	15±9.02	13.40±9.9*	Z=2.172
Length of hospital stay	15±9.02	13.40±9.9*	P=0.03
Mortality (n=30)	10 (18.2%)	20 (16.4%)	χ²=0.086
Mortality (n=30)	10 (18.2%)	20 (16.4%)	P=0.769
Postoperative CVD (n=4)	1 (1.9%)	3 (2.5%)	χ²=0.062
Postoperative CVD (n=4)	1 (1.9%)	3 (2.5%)	P=0.803
Postoperative AF (n=54)	19 (35.2%)	35 (28.7%)	χ²=0.743
Postoperative AF (n=54)	19 (35.2%)	35 (28.7%)	P=0.389
Postoperative AKI (n=25)	9 (16.4%)	16 (13.2%)	χ²=0.306
Postoperative AKI (n=25)	9 (16.4%)	16 (13.2%)	P=0.580
DSSI (n=6)	0	6 (13.6%)*	χ²=1.981
DSSI (n=6)	0	6 (13.6%)*	P=0.159

Authors' roles & responsibilities
RÖ	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; final approval of the version to be published
AT	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; final approval of the version to be published
HY	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; final approval of the version to be published
GS	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; final approval of the version to be published
HKT	Substantial contributions to the conception or design of the work; or the acquisition, analysis or interpretation of data for the work; final approval of the version to be published

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