Influence of Diabetes Mellitus on Changes in Intra-Operative Decision Making in Coronary Artery Bypass Grafting

Abstract

Background: We evaluated whether patients with diabetes mellitus experienced more surgical strategy changes than patients without diabetes when undergoing coronary artery bypass graft surgery utilizing a protocol for intraoperative high frequency ultrasound and transit-time flow measurement. Methods: Outcomes of coronary artery bypass grafting (CABG) patients with and without diabetes enrolled in the multicenter prospective Registry for Quality Assessment with Ultrasound Imaging and TTFM in Cardiac Bypass Surgery (REQUEST) study were retrospectively compared. The primary endpoint was frequency of intraoperative surgical strategy changes. We also evaluated the differences in patient characteristics and operative characteristics including graft configuration. Results: We compared 614 non-diabetic patients with 402 diabetic patients, among whom 128 were insulin dependent. Patients with diabetes had higher rates of surgical strategy change for the aortic component of the operation (10.2% vs. 6.4%, odds ratio (OR) = 1.67; 95% confidence interval (CI) = 1.06–2.65; p = 0.026). Surgical strategy changes related to in-situ conduits were more common in on-pump procedures in comparison to off-pump in diabetics (4.0% vs. 0%; p = 0.007). Diabetes was associated with less frequent use of bilateral internal mammary arteries (BIMA) (25.6% vs. 33.7%; p = 0.006), more frequent use of radial artery (31.3% vs. 16.9%; p < 0.001) and multi-arterial configuration (48.3% vs. 39.9%, p = 0.009), and more total grafts (3.1 ± 1.1 vs. 2.8 ± 0.9; p < 0.001). Conclusions: When performing isolated CABG on diabetic patients, surgeons were more likely to change surgical strategy for the aortic component of the operation based on high-frequency ultrasound (HFUS), and more likely to make a change related to in-situ conduits in on-pump procedures in diabetics. Among diabetic patients, there was less frequent use of BIMA, more frequent use of radial artery, more frequent multi-arterial configuration, and more total grafts.