CORONARY ARTERY BY PASS GRAFTING

EARLY MORBIDITY AND MORTALITY IN PATIENTS WITH TIGHT GLYCAEMIC CONTROL VERSUS STANDARD CONTROL

Abstract

Background: Several studies have suggested superiority of tight glycaemic control in reducing the incidence of surgical site infection and mortality after cardiac surgery. Objective: To compare the frequency of post operative surgical site infections after CABG in patients with tight glycamic control and those with standard glycamic control. Setting: Shaikh Zayed Hospital, Lahore. Period: June 2008 to March 2010. Methods: Total of 496 patients were included, they were randomized to tight glycaemic control group (TGC ,n =248) or standard control group(SC, n=248).In TGC group blood glucose was maintained between 90 – 130 mg/dl, while in SC group blood glucose was maintained between 131- 190mg/dl for 48 hours post surgery. Results were prospectively evaluated. Results: Demographic and surgical data was similar in both groups. Patients in TGC group showed significant reduction in post operative superficial sternal wound infection (4 vs 12 , p < 0.05) , deep sternal wound infection (1 vs 7, p <0.05) and leg wound infection ( 2vs 9, p<0.05).There was also non significant reduction in the incidence of post operative mediastinitis (1 vs 3), new myocardial infarction ( 2 vs 3),and atrial fibrillation (10 vs 12). Mortality was equal in both groups (1 in each). Conclusions: Significant reduction in SSI was observed in TGC group and no change was seen in other morbidities and short term mortality in the study.