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Item #2
Bypass
Surgery More Dangerous for Diabetic Patients
Midterm
mortality and morbidity were significantly greater for patients with
diabetes.
Diabetic
patients who undergo coronary artery bypass grafting (CABG) had a
30-day mortality rate similar to that of non-diabetic patients, but
midterm mortality and morbidity were significantly greater, according
to researchers in Sweden.
"An
increasing proportion of patients undergoing coronary artery bypass
grafting are diabetics," commented Zoltan Szabo and colleagues at
Linkoping Heart Center.
Szabo
and associates determined patient characteristics and early and
midterm mortality and morbidity in 2779 subjects (539 diabetic, 2240
nondiabetic) who underwent CABG in 1995 to 1999.
The
investigators found that the diabetic CABG patients were younger, more
likely to be female, and had a higher incidence of high blood
pressure, triple-vessel involvement, and unstable angina. Bypass and
cross-clamp times were longer for diabetic than for non-diabetic
patients, and the diabetic patients required a greater number of
bypasses.
Blood
transfusions, dialysis, and the use of inotropic drugs were more
common in the diabetic than in the non-diabetic patients, and ICU and
hospital stays were longer (Early postoperative outcome and
medium-term survival in 540 diabetic and 2,239 non-diabetic patients
undergoing coronary artery bypass grafting. Annals
of Thoracic Surgery, 2002;74(3):712-719).
Stroke
occurred in 4.3% of the diabetic patients compared with 1.7% of the
non-diabetic patients. Other complications, such as kidney failure,
infections, and mediastinitis, also occurred more frequently in the
diabetic patients than in the non-diabetic patients.
The
30-day mortality for the diabetic patients (2.6%) was not
significantly different than that for the non-diabetic patients
(1.6%), but the cumulative 5-year survival rate was significantly
lower (84.4% vs. 91.3%, respectively; 0<0.001).
"Short-term
mortality was acceptable in diabetic patients after CABG, but they had
increased postoperative morbidity in comparison with non-diabetic
patients, particularly with regard to renal function, cerebral
complications, and infections," concluded Szabo and
collaborators. "Midterm survival was impaired in diabetic
patients mainly because of a less favorable outcome in patients
treated with insulin."
Key
points reported in this study include:
*
After coronary artery bypass grafting, diabetic patients had a 30-day
mortality rate similar to that for nondiabetic patients but had a
significantly lower 5-year survival rate
*
Among patients who underwent CABG, diabetic patients had higher rates
of complications such as stroke, kidney failure, mediastinitis, and
wound infections
*
Among patients who underwent CABG, diabetic patients were more likely
than nondiabetic patients to require inotropic drugs, blood
transfusions, and dialysis This article was prepared by Diabetes Week
editors from staff and other reports.
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FACT
In
1997, a total of 74,927 workers were reported to be permanently
disabled because of Diabetes. Diabetes-related hospitalizations
accounted for 13.9 million hospital days in 1997. The mean length of
stay was 5.4 days. (American
Diabetes Association, 1998).
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