Effect of HBA1C level on Post-Operative complications post cardiac surgery

ABSTRACT

Introduction: The American Diabetes Association (ADA) recommends Glycated Hemoglobin (HbA1c) for assessing long-term glycemic control in diabetic patients.

Aim of the Work: To assess the effect of HbA1c level on post cardiac surgery complications.

Methodology: In our study, we sought to assess the effect of HbA1c level on post cardiac surgery complications. The study comprised 40 patients, who were initially classified according to their glycemic control status with HbA1c cut off value of 7% into 2 groups, 20 patients in each group (group 1 HbA1c <7%; Group 2 HbA1c >7%). Of all included patients, regardless of the HbA1c level, 25 patients (62%) were previously known to be diabetics, 8 (48%) were discovered to be diabetic on pre-operative assessment, and 7(17.5%) were non-diabetics. To evaluate the effect of HbA1c rather than diabetes per se, we further sub-grouped our patients into 4 groups, Non diabetics, known diabetics with good control or those with poor control, and those accidently discovered with poor control.

Results: The main findings of our study showed that patients with HbA1c> 7% had a significantly higher occurrence both major and minor complications. Specifically, group 2 had a higher occurrence of post-operative LV dysfunction, higher incidence of DKA, high base deficit and lactate as early post-operative complications; and more wound infection, and prolonged MV, with more patients requiring ICU stay for more than 3 days as late post-operative complication. Moreover, when considering the previous history of diabetes, known diabetic uncontrolled patients had the highest incidence of complications, while controlled diabetic patients had a significantly lower incidence of complications than those accidently discovered and similar to non-diabetic patients. Finally, HbA1c level positively correlated with S. lactate, and a cut value of 6.7% was predictive of post-operative complication with a sensitivity of 85% and specificity of 78%.

Conclusion: Glycated Hb is an important predictor for minor and major complications occurring early or late post cardiac surgery, the control of blood sugar is a more important than the diabetic history, per se, in predicting post-cardiac surgery complication.

Key words:  CABG (coronary artery bypass graft), HbA1c (glycated hemoglobin), DKA (diabetic ketoacidosis).

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