Greater functional improvement in patients with diabetes after rehabilitation following cardiac surgery

Abstract

Diabetes increases the risk of in-hospital complications in medical or surgical patients. Few data are available in the rehabilitation phase after cardiac surgery. To assess the influence of diabetes on outcome and complication rate in the rehabilitation phase after cardiac surgery. Data prospectively recorded in the Hospital Information System from 5261 patients consecutively admitted between 1 January 2008 and 31 May 2013 for a comprehensive cardiac rehabilitation programme directly after cardiac surgery were analysed retrospectively. The study cohort included 1285 (24%) patients with diabetes and 3976 (76%) without. Coronary artery bypass graft (CABG) was more frequent in patients with diabetes (58% vs. 37%, P<0.01), and valvular surgery was more frequent in patients without diabetes (37% vs. 22%, P<0.01). Patients with diabetes were more disabled after surgery, with severe disability (Barthel Index <60) observed in 22% (vs. 17% in patients without diabetes, P<0.001). During rehabilitation, complications were more frequent in patients with diabetes than those without (28% vs. 21%, P<0.01); in particular, patients with diabetes had more infections, heart failure and more difficult surgical wound healing. However, the improvement in the Barthel Index was greater in patients with diabetes (+16±15) than without (+13±15, P<0.001). In a large cohort of patients directly admitted to an early inpatient rehabilitation programme after cardiac surgery, those with diabetes were more disabled. Nonetheless, and despite the higher rate of complications, patients with diabetes had the greatest benefit in terms of functional improvement.