Clinical and Economic Impact of Diabetes Following Coronary Artery Bypass

Abstract

Background.Diabetes has been shown to have a negative impact on mortality following coronary artery bypass graft (CABG) surgery. This analysis examines the impact of diabetes on additional clinical and economic outcomes.Material and methods.Between May and October of 1996, 312 consecutive patients undergoing isolated primary CABG were followed through hospital discharge. A total of 114 diabetics (37%) and 198 nondiabetics (63%) was evaluated. Among the diabetics, 62 (54%) were insulin requiring and 52 (46%) were treated with oral hypoglycemic agents or with diet alone.Results.The incidences of major clinical complications including death, renal failure, stroke, reexploration for bleeding, and mediastinitis or sternal dehiscence were not significantly different among insulin-requiring diabetics, noninsulin-requiring diabetics, and nondiabetics. However, insulin-requiring diabetics had a significantly longer (P< 0.01) total length of stay compared to both noninsulin-requiring diabetics and nondiabetics (10.7 ± 12.7 days vs. 5.6 ± 1.5 days vs. 6.8 ± 5.4 days, respectively), a significantly longer (P< 0.01) intensive care unit length of stay (5.3 ± 12.4 days vs. 1.4 ± 0.8 days vs. 2.0 ± 3.9 days, respectively), and significantly greater (P< 0.01) total hospital charges (48.7 ± 56.1 thousand dollars vs. 29.3 ± 4.3 thousand dollars vs. 32.9 ± 18.9 thousand dollars, respectively). There were no significant differences between the noninsulin-requiring diabetics and the nondiabetics with regard to these clinical and economic outcomes.Conclusions.Diabetics treated with oral hypoglycemic agents or with diet alone have clinical and economic outcomes similar to nondiabetics following CABG. Insulin-requiring diabetes, however, predicts significantly increased hospital resource utilization. Future outcome assessment and resource utilization analyses must stratify diabetes by treatment to be completely accurate.