WHAT IS THE RELATIONSHIP BETWEEN STRICT GLUCOSE CONTROL AND THE DEVELOPMENT OF POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY?

Running head : POSTOPERATIVE GLYCEMIC CONTROL

What is the relationship between strict glycemic control and the development of postoperative complications in diabetic and non-diabetic inpatients undergoing Coronary Artery Bypass Surgery

April 2008

The Coronary artery bypass graft (CABG ) procedure is commonly used among patients with cardiovascular disease (Lorenz , Lorenz Codd 2005 . However , depending on the individual characteristics of patients undergoing this procedure and other hospital , surgical and physician-related factors , a number of adverse complications may develop and produce negative effects on patient outcomes . Hospital-acquired infections (HAIs , particularly surgical site infections

(SSIs , may contribute significantly to patient outcomes . HAIs , also called nosocomial infections , are infections that are acquired by patients in the hospital setting from anywhere around 48 hours of admission (CDC 2007 . These infections are not directly related to the original condition for which the patient reported but HAIs come about as a result of a procedure or treatment utilized in their diagnosis or treatment (Rizzo Odle , 2006 . Hospital acquired infections are the leading cause of complications in patients that are hospitalized (Mohr , Peninger Ostrosky-Zeichner , 2005

In patients undergoing CABG a number of cardiovascular complications may also impact patient outcomes . Such complications include mortality usually within 30 days of the procedure patients may experience strokes , myocardial infarctions , pneumonia , reintubation , renal failure extended hospital stay and similar complications (Yap , Mohajeri Yii 2007 . Additionally individual patient characteristics may put CABG patients at a heightened risk of developing these infections or complications during and /or after surgery . Patients with diabetes have been shown to have poorer outcomes than other patients with respect to a multiplicity of surgical procedures , including CABG (Lorenz et al 2005

Within the hospital setting it is important that proper procedures and practices are followed in to minimize the negative outcomes of surgical procedures . The United States government , through its Center for Disease Control and Prevention (See www .cdc .gov , has continuously emphasized the need to ensure patient safety by adopting strict evidence-based practices , to ensure that complications are minimized and that patients receive the optimal level of care possible for their condition . Researchers have revealed that hyperglycemia negatively affects patient outcomes by increasing mortality and morbidity . Research has also shown that patients with diabetes are at an increased risk of developing complications and thus may have poorer outcomes than their non-diabetic counterparts (Lorenz et al , 2005 . Pennel , Smith-Snyder Hudson , Hamar and Westerfield (2005 ) suggested that strict glycemic control , as a mechanism to monitor hyperglycemia , was effective in improving mortality and morbidity outcomes in patients undergoing CABG surgery

Hospitals should be interested in how patient outcomes are monitored in their individual settings and seek to improve practices that do not meet minimum standards , leading eventually to improved patient outcomes Though statistics may exist at a national level describing critical care nurses ' adherence to prescribed practice guidelines on best techniques to diminish the possible negative outcomes in patients undergoing CABG surgery , it is important to understand the true nature of these practices at the individual hospital level so that necessary programs...