Glucose Control During Surgery Linked to Better OutcomesLast Updated: April 28, 2009. Aggressive glycemic control during surgery reduces the risk of major cardiovascular events, researchers report in the May issue of Anesthesiology.
TUESDAY, April 28 (HealthDay News) -- Aggressive glycemic control during surgery reduces the risk of major cardiovascular events, researchers report in the May issue of Anesthesiology.
Balachundhar Subramaniam, M.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues randomly assigned 236 patients undergoing non-cardiac surgery (peripheral vascular bypass, abdominal aortic aneurysm repair, and below or above knee amputations) to a continuous insulin infusion (for glycemic control) or a standard intermittent insulin bolus (poor glycemic control).
The researchers found that glycemic control (target glucose 100 to 150 mg/dL) significantly reduced the rate of all-cause death, myocardial infarction, or acute congestive heart failure (3.5 versus 12.3 percent, relative risk 0.29). Hypoglycemia was more common with glycemic control (8.8 versus 4.1 percent), although this did not reach statistical significance. After adjusting for possible confounding factors, glycemic control was an independent negative predictor of adverse events, while previous coronary artery disease was a positive predictor, the authors report.
"In conclusion, the results demonstrate that continuous infusion of insulin in hyperglycemic patients, with or without diabetes, substantially decreases major cardiovascular events compared with patients receiving intermittent bolus insulin," Subramaniam and colleagues write. "This beneficial effect was observed concomitantly with a low risk of hypoglycemia."
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