3. The impact of elevated HbA1c on Surgical Site Infection and other infectious morbidities after isolated coronary artery bypass surgery

Abstract

Background & Aim of the study Wound infection is an important cause of morbidity and mortality after coronary artery bypass surgery (CABG). Patients with diabetes represent a high risk group for patients undergoing CABG. Glycosylated hemoglobin (HbA1c), a measure of hyperglycemia, is a sensitive and reliable marker of impaired glucose metabolism. The aim of the study is to compare the impact of the elevated (HbA1c), on the post-operative risk of Surgical Site Infection (SSI) and other infectious morbidities and mortality after isolated CABG. Patients & methods Two hundred and fifty patients (190 males, 65 females; mean age 62.69 ± 11.00; range 38–85 years) who underwent coronary artery bypass surgery at our center between January and December 2012 were enrolled in this study. All patients including the non-diabetics were managed with a specialized hospital protocol for glycemic control in the perioperative period. Results Out of the 255 patients, 169 patients (66.3%) had elevated preoperative HbA1c and 183 (71.8%), were diabetics. Surgical Site infection were observed in 26 patients with elevated HbA1c and 2 patients in the normal HbA1c group respectively (15. 3% vs 3.6%, p = 0.002), Pneumonia, were observed in 11 in the elevated and 3 in the normal HbA1c respectively (6.5% vs 5.5%), Furthermore, Septicemia was observed in 3 patients (1.8%) with elevated HbA1c. The 30 days mortality was Zero in both groups. Conclusion Our cohorts of patients have a high incidence of diabetes, and 66.3% of the patients have elevated HbA1c at the time of surgery. Patients with elevated HbA1c, undergoing isolated coronary artery bypass surgery have a significantly higher risk of surgical site infection and may have a higher risk of other infectious complications, but have no impact on early mortality.