Background: Most studies demonstrating the benefit of perioperative glycemic control in patients undergoing CABG have primarily focused on inpatient glucose management protocols only. Our study evaluated outcomes before and after implementation of an innovative, comprehensive cardiovascular diabetes program in patients with diabetes undergoing CABG.
Methods: In March 2015, Sentara Heart Hospital and Eastern Virginia Medical School implemented a Multidisciplinary Cardiovascular Diabetes Program. The inpatient aspect focuses on patient education and optimizing glycemic control with the use of Glucommander, an electronic glucose management system. Representatives from endocrinology, cardiology and cardiothoracic surgery meet monthly to review outcomes and develop policy. Patients return for a visit with the surgical and endocrine teams 1-2 weeks after discharge, followed by cardiac rehabilitation. Our retrospective study was designed to compare clinical outcomes for the period of 2 years pre- and 2 years post-implementation of the program. Data from 1013 patients (444 pre; 569 post) were extracted from the Society of Thoracic Surgeons CABG database and the EPIC electronic health record.
Results: After implementation of the program, the frequency of blood glucose values <70 mg/dl was reduced by 42% (from 1.52% to 0.89%; p < 0.001) and the length of stay (LOS) decreased from 12.4 days to 11.2 days (p = 0.026). Multiple regression analyses showed the post-implementation period was associated with shorter LOS and reduced hospital charges. Poor glycemic control, infections and cardiovascular complications had a negative effect on LOS, readmissions and hospital charges.
Conclusion: The implementation of a comprehensive, multidisciplinary program for patients with diabetes undergoing CABG resulted in significantly less hypoglycemia, shorter LOS and reduced hospital charges.
E.S. Siraj: Advisory Panel; Self; Sanofi. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. A. Nelson: None. J.E. Brush: None. J. Ullal: None. R. Lamichhane: None. B.E. Sheehan: None.
EVMS-Sentara Healthcare Analytics and Delivery Science Institute