Results
A total of 90 patients who underwent cardiac surgery at the Cardiothoracic Surgery operating room in tertiary city hospital were included in the study. Seven patients were not analyzed due to lost of follow-up. NIDDM was detected in 19 of 83 patients included and determined as group NIDDM, the remaining non-diabetic 64 patients were determined as group NoDM. In only 5 patients in the non-diabetic patient group, blood glucose levels did not exceed 140 during the operation, so the rate of stress hyperglycemia was 78%. In the NIDDM group, blood glucose levels were high from the beginning.
Pre-operative and intra-operative demographic and clinical characteristics of the study population are summarized in Table 1. There were no statistically significant difference in the age, gender, comorbidities, duration of CPB, and aortic clamping between groups (Table 1).
The characteristics of hemodynamic and tissue oxygenation parameters during surgery of groups were shown in Table 2. The glucose values were significantly different between groups. There was a statistically significant effect of DM on blood glucose values (p<.001) as expected. NIDDM patients had 1.67 times higher blood glucose values than those with NoDM, (p<0.05) [95% CI: 1.47, 1.91]. In general, time has a positive and statistically significant effect on blood glucose levels (p<.001). As time progresses, blood sugar increases 1.18 times (p<0.05) [95% CI: 1.17, 1.20]. When the change in the blood glucose values of the patients in the NIDDM and NoDM groups is examined, the blood glucose levels of the patients with NIDDM increase 0.879 times as time progresses, while the patients with NoDM increase 1/0.879=1.14 times as time progresses (Figure 1). Hypoglycemic attack was not observed in any patient.
The O2ER values were significantly different between groups when repeated measurements were analyzed together with GEE method (p=0.004) (Figure 2). There is a statistically significant difference between the groups at the 4th time point (p=0.022). Patients in the NIDDM group had higher O2ER values than patients in the NoDM group at time points 1, 2, and 4. NIDDM patients had 1.22 times higher O2ER values than those with NoDM, and this result was statistically significant [95% CI: 1.06-1.40]. There was no statistically significant effect of time on O2ER values (p=0.746).
There was no statistically significant effect of blood glucose values on O2ER (p=0.549), and also no statistically significant effect of O2ER values on blood glucose was found (p=0.578).
There was no statistically difference at lactate level, DO2, VO2, SVR, ScvO2, Hb, MAP, HR, temperature, and urine output values between groups.
Intraoperative inotropic medications, blood product transfusion rates, postoperative complications, and mortality data were not statistically different as shown in Table 3.