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Journal of Cardiothoracic Surgery
Published in: Journal of Cardiothoracic Surgery 1/2011

Open Access 01-12-2011 | Research article

The effect of tight glycaemic control, during and after cardiac surgery, on patient mortality and morbidity: A systematic review and meta-analysis

Authors: Kristin K Haga, Katie L McClymont, Scott Clarke, Rebecca S Grounds, Ka Ying B Ng, Daniel W Glyde, Robert J Loveless, Gordon H Carter, R Peter Alston

Published in: Journal of Cardiothoracic Surgery | Issue 1/2011

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Abstract

Background

Hyperglycaemia is a common occurrence during cardiac surgery, however, there remains some uncertainty surrounding the role of tight glycaemic control (blood glucose <180 mg/dL) during and/or after surgery. The aim of this study was to systematically review the literature to determine the effects of tight versus normal glycaemic control, during and after cardiac surgery, on measures of morbidity and mortality.

Method

The literature was systematically reviewed, based on pre-determined search criteria, for clinical trials evaluating the effect of tight versus normal glycaemic control during and/or after cardiac surgery. Each paper was reviewed by two, independent reviewers and data extracted for statistical analysis. Data from identified studies was combined using meta-analysis (RevMan5®). The results are presented either as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CIs).

Results

A total of seven randomised controlled trials (RCTs) were identified in the literature, although not all trials could be used in each analysis. Tight glycaemic control reduced the incidence of early mortality (death in ICU) (OR 0.52 [95% CI 0.30, 0.91]); of post-surgical atrial fibrillation (odds ratio (OR 0.76 [95%CI 0.58, 0.99]); the use of epicardial pacing (OR 0.28 [95%CI 0.15, 0.54]); the duration of mechanical ventilation (mean difference (MD) -3.69 [95% CI -3.85, -3.54]) and length of stay in the intensive care unit (ICU) (MD -0.57 [95%CI -0.60, -0.55]) days. Measures of the time spent on mechanical ventilation (I2 94%) and time spent in ICU (I2 99%) both had high degrees of heterogeneity in the data.

Conclusion

The results from this study suggest that there may be some benefit to tight glycaemic control during and after cardiac surgery. However, due to the limited number of studies available and the significant variability in glucose levels; period of control; and the reporting of outcome measures, further research needs to be done to provide a definitive answer on the benefits of tight glycaemic control for cardiac surgery patients.
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Metadata
Title
The effect of tight glycaemic control, during and after cardiac surgery, on patient mortality and morbidity: A systematic review and meta-analysis
Authors
Kristin K Haga
Katie L McClymont
Scott Clarke
Rebecca S Grounds
Ka Ying B Ng
Daniel W Glyde
Robert J Loveless
Gordon H Carter
R Peter Alston
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2011
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/1749-8090-6-3

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