Patients with type 2 diabetes undergoing coronary artery bypass graft surgery: Predictors of outcomes

Abstract

Type 2 diabetic (T2DM) patients undergoing CABG have worse outcomes than non-diabetic patients, especially if insulin-treated. The purpose of this study was to determine if pre-hospital management of diabetes (including insulin) and risk factors affect outcomes. Methods: T2DM patients were recruited at time of CABG and followed 3 months. Variables were illness level factors: insulin treatment, risk factor management, heart disease measures; Predisposing Factors: demographics, health status (SF-36), Geriatric Depression Scale (GDS), Charlson Co-morbidity Index (CCI); Outcomes: post-operative length of stay (PLOS), complications, re-hospitalisation. Results: 317 T2DM patients (mean age 66, female 37%) had poor health status, met half the risk factor goals, and 27% had depressive symptoms. Mean PLOS was 7.4 ± 5 days, 44% had complications, and 32% were re-hospitalised. Insulin-treated patients were at higher risk and had worse outcomes. Independent predictors of outcomes: CCI and measures of left ventricular function (all outcomes); risk factor management (complications); insulin treatment, GDS, age (PLOS); female sex, BMI, PLOS (re-hospitalisation). Conclusions: Insulin treatment in T2DM patients indicates patients at high risk of poor outcomes. Intensive management and rehabilitation is needed to improve outcomes, and patients would benefit from optimal management of risk factors pre- and post-CABG. © 2008 European Society of Cardiology.