Background: Diabetes has been shown to have a negative impact on mortality following coronary artery bypass graft (CABG) surgery. This analysis examines the impact of diabetes on additional clinical and economic outcomes.
Material and methods: Between May and October of 1996, 312 consecutive patients undergoing isolated primary CABG were followed through hospital discharge. A total of 114 diabetics (37%) and 198 nondiabetics (63%) was evaluated. Among the diabetics, 62 (54%) were insulin requiring and 52 (46%) were treated with oral hypoglycemic agents or with diet alone.
Results: The incidences of major clinical complications including death, renal failure, stroke, reexploration for bleeding, and mediastinitis or sternal dehiscence were not significantly different among insulin-requiring diabetics, noninsulin-requiring diabetics, and nondiabetics. However, insulin-requiring diabetics had a significantly longer (P < 0.01) total length of stay compared to both noninsulin-requiring diabetics and nondiabetics (107 +/- 12.7 days vs. 5.6 +/- 1.5 days vs. 6.8 +/- 5.4 days, respectively), a significantly longer (P < 0.01) intensive care unit length of stay (5.3 +/- 12.4 days vs. 1.4 +/- 0.8 days vs. 2.0 +/- 3.9 days, respectively), and significantly greater (P, 0.01) total hospital charges (48.7 +/- 56.1 thousand dollars vs. 29.3 +/- 4.3 thousand dollar vs. 32.9 +/- 18.9 thousand dollars, respectively). There were no significant differences between the noninsulin-requiring diabetics and the nondiabetics with regard to these clinical and economic outcomes.
Conclusions: Diabetics treated with oral hypoglycemic agents or with diet alone have clinical and economic outcomes similar to nondiabetics following CABG. Insulin-requiring diabetes, however, predicts significantly increased hospital resource utilization. Future outcome assessment and resource utilization analyses must stratify diabetes by treatment to be completely accurate.