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(Circulation. 2008;118:2235-2242.)
© 2008 American Heart Association, Inc.

Congenital Heart Disease

Association Between Intraoperative and Early Postoperative Glucose Levels and Adverse Outcomes After Complex Congenital Heart Surgery

Angelo Polito, MD; Ravi R. Thiagarajan, MBBS, MPH; Peter C. Laussen, MBBS; Kimberlee Gauvreau, ScD; Michael S.D. Agus, MD; Mark A. Scheurer, MD; Frank A. Pigula, MD; John M. Costello, MD, MPH

From the Departments of Cardiology (A.P., R.R.T., P.C.L., K.G., M.A.S., J.M.C.), Medicine (M.S.D.A.), and Cardiac Surgery (F.A.P.), Children’s Hospital Boston, Harvard Medical School, Boston, Mass; and Department of Pediatric Cardiology and Cardiac Surgery (A.P.), Bambino Gesù Hospital, Rome, Italy.

Reprint requests to John M. Costello, MD, MPH, Assistant Professor of Pediatrics, Harvard Medical School, Division of Cardiac Intensive Care, Department of Cardiology, Children’s Hospital Boston, 300 Longwood Ave, Bader 600, Boston, MA 02115. E-mail john.costello{at}cardio.chboston.org

Received July 3, 2008; accepted September 16, 2008.

Background— This study sought to determine whether associations exist between perioperative glucose exposure, prolonged hospitalization, and morbid events after complex congenital heart surgery.

Methods and Results— Metrics of glucose control, including average, peak, minimum, and SD of glucose levels, and duration of hyperglycemia were determined intraoperatively and for 72 hours after surgery for 378 consecutive high-risk cardiac surgical patients. Multivariable regression analyses were used to determine relationships between these metrics of glucose control, hospital length of stay, and a composite morbidity-mortality outcome after controlling for multiple variables known to influence early outcomes after congenital heart surgery. Intraoperatively, a minimum glucose 75 mg/dL was associated with greater adjusted odds of reaching the composite morbidity-mortality end point (odds ratio [OR], 3.10; 95% confidence interval [CI], 1.49 to 6.48), but other metrics of glucose control were not associated with the composite end point or length of stay. Greater duration of hyperglycemia (glucose >126 mg/dL) during the 72 postoperative hours was associated with longer duration of hospitalization (P<0.001). In the 72 hours after surgery, average glucose <110 mg/dL (OR, 7.30; 95% CI, 1.95 to 27.25) or >143 mg/dL (OR, 5.21; 95% CI, 1.37 to 19.89), minimum glucose 75 mg/dL (OR, 2.85; 95% CI, 1.38 to 5.88), and peak glucose level 250 mg/dL (OR, 2.55; 95% CI, 1.20 to 5.43) were all associated with greater adjusted odds of reaching the composite morbidity-mortality end point.

Conclusions— In children undergoing complex congenital heart surgery, the optimal postoperative glucose range may be 110 to 126 mg/dL. Randomized trials of strict glycemic control achieved with insulin infusions in this patient population are warranted.

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Clinical Summaries
Circulation 2008 118: 2219-2220. [Extract] [Full Text]