Abstract 2081: Hyperglycemia and Outcome After Pediatric Cardiac Surgery: Effects of Age and Residual Lesions
The link between post-operative hyperglycemia and adverse outcomes after pediatric cardiac surgery is controversial and may depend on factors such as age or residual lesions. We reviewed all children undergoing surgery with CPB at our institution during calendar years 2006 and 2007 (n=772) for an association between hyperglycemia and postoperative outcomes, emphasizing how important covariates might influence this relationship. The composite outcome combined hospital death or cardiac arrest, renal/hepatic failure, cardiogenic shock, ECMO, or infection. Hyperglycemia occurred in 90% of patients and resolved within 72 hours in most. Pre-operative prostaglandins, mechanical ventilation and cyanosis were strongly associated with hyperglycemia as were increased surgical complexity and peri-operative steroids. Multivariable logistic regression showed that the overall probability of the composite outcome in the entire cohort was 0.31, and increased after more than 54 hours of mild hyperglycemia (>ULN, but <180 mg/dL), 12 hours of moderate (>180 mg/dL) or any period of severe (>270 mg/dL) (Figure⇓). Neonates tolerated longer periods of hyperglycemia before showing increased risk of the composite outcome. In the setting of important residual lesions, mild or moderate hyperglycemia was not as strong an independent associated factor for poor outcomes as it was in the absence of residual lesions. We conclude that age and presence of residual lesions are important modifiers of the association between hyperglycemia and outcome after cardiac surgery in infants and children. Use of insulin for tight glucose control in this patient population may need to be carefully targeted.