Gökhan İPEK, Deniz GÖKSEDEF, Suat Nail ÖMEROĞLU, Emine Şeyma Denli YALVAÇ, Macit BATARGİL

Is elevated HbA1c a risk factor for infection after coronary artery bypass grafting surgery?

Amaç: Koroner arter bypass greftleme ameliyatı sonrasında glikosilat hemoglobin (HbA1c)’nin etkileri ve ameliyat sırası glikoz seviyelerinin erken dönem sonuçları karşılaştırıldı.Çalışma planı: Nisan 2007 - Aralık 2008 tarihleri arasında kliniğimizde koroner arter bypass greftleme ameliyatı olan 150 hasta (106 erkek 44 kadın; ort. yaş 61.69±10.06 yıl; dağılım 37-84 yıl) ileriye dönük olarak çalışmaya dahil edildi. Diyabetik olmayan hastalar da dahil her hastaya ameliyat sırası glikoz kontrolü için Portland protokolü uygulandı.Bulgular: İki hastada mediyastenit görüldü (%1.3). Yüksek HbA1c seviyelerinin erken dönemde enfeksiyoz komplikasyonları etkilemediği görüldü, buna karşın ameliyat sırası ortalama glikoz seviyesi yüksek hastalarda mediyastenit (%0’a karşın %3, p=0.01) ve lokal sternal infeksiyonlara (%2.3’e karşın %12.1, p=0.002) daha sık rastlandı.Sonuç: Koroner arter bypass greftleme ameliyatı sırasında yapılan yetersiz glikoz kontrolü ameliyat sonrası enfeksiyöz komplikasyon sıklığını olumsuz etkiler, ancak yüksek HbA1c seviyeleri ameliyat sonrası infeksiyon komplikasyonu için herhangi bir risk oluşturmaz.

Yüksek HbA1c koroner arter bypass greftleme cerrahisi sonrası infeksiyon için bir risk faktörü müdür?

Background: The effect of glycosylated hemoglobin (HbA1c) and perioperative glucose levels on short term results following coronary artery bypass grafting surgery were compared.Methods: One hundred and fifty patients (106 males, 44 females; mean age 61.69±10.06 years; range 37 to 84 years), who underwent coronary artery bypass grafting surgery in our clinic between April 2007 and December 2008, were enrolled in this study prospectively. Every patient including non-diabetics were managed with Portland protocol in the perioperative period.Results: Mediastinitis was observed in two patients (1.3%). Elevated HbA1c levels do not affect the short term infectious complications, however the patients who had elevated perioperative glucose levels had higher incidence (0 vs 3%, p=0.01) of mediastinitis and local sternal infection (2.3% vs 12.1%, p=0.002).Conclusion: Poor perioperative glucose management affects and increases the rate of postoperative infections as expected but elevated HbA1c levels do not cause any risks in infectious complications following coronary artery bypass grafting surgery.

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