University of Oulu

Francesco Nicolini, Giuseppe Santarpino, Giuseppe Gatti, Daniel Reichart, Francesco Onorati, Giuseppe Faggian, Magnus Dalén, Sorosh Khodabandeh, Theodor Fischlein, Daniele Maselli, Saverio Nardella, Antonino S. Rubino, Marisa De Feo, Antonio Salsano, Riccardo Gherli, Giovanni Mariscalco, Eeva-Maija Kinnunen, Vito G. Ruggieri, Karl Bounader, Matteo Saccocci, Sidney Chocron, Juhani Airaksinen, Andrea Perrotti, Fausto Biancari, Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery: Prospective, cohort study from the E-CABG registry, International Journal of Surgery, Volume 53, 2018, Pages 354-359, ISSN 1743-9191,

Utility of glycated hemoglobin screening in patients undergoing elective coronary artery surgery : prospective, cohort study from the E-CABG registry

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Author: Nicolini, Francesco1; Santarpino, Giuseppe2; Gatti, Giuseppe3;
Organizations: 1Division of Cardiac Surgery, University of Parma, Parma, Italy
2Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany
3Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy
4Hamburg University Heart Center, Hamburg, Germany
5Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy
6Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
7Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy
8Centro Cuore Morgagni, Pedara, Italy
9Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy
10Division of Cardiac Surgery, University of Genoa, Genoa, Italy
11Department of Cardiovascular Sciences, Cardiac Surgery Unit, S. Camillo-Forlanini Hospital, Rome, Italy
12Department of Cardiovascular Sciences, Clinical Sciences Wing, University of Leicester, Glenfield Hospital, Leicester, UK
13Department of Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
14Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
15Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Reims, France
16Department of Cardiac Surgery, Centro Cardiologico–Fondazione Monzino IRCCS, University of Milan, Italy
17Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France
18Heart Center, Turku University Hospital and University of Turku, Turku, Finland
19Department of Surgery, University of Turku, Turku, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
Persistent link:
Language: English
Published: Elsevier, 2018
Publish Date: 2019-10-21


Background: Patients with increased glycated hemoglobin (HbA1c) seem to be at increased risk of sternal wound infection (SWI) after coronary artery bypass grafting (CABG). However, it is unclear whether increased baseline HbA1c levels may affect other postoperative outcomes.

Material and methods: Data on preoperative levels of HbA1c were collected from 2606 patients undergoing elective isolated CABG from 2015 to 2016 and included in the prospective, multicenter E-CABG registry.

Results: The prevalence of HbA1c ≥ 53 mmol/mol (7.0%) among non-diabetics was 5.3%, among non-insulin dependent diabetics was 53.5% and among insulin dependent diabetics was 67.1% (p < 0.001). The prevalence of HbA1c > 75 mmol/mol (9.0%) among non-diabetics was 0.5%, among non-insulin dependent diabetics was 5.8% and among insulin dependent diabetics was 10.6% (p < 0.001). Baseline levels of HbA1c ≥ 53 mmol/mol (7.0%) was a significant predictor of any SWI (10.7% vs. 3.3%, adjusted p-value: <0.001), deep SWI/mediastinitis (3.8% vs. 1.3%, adjusted p-value: 0.001) and acute kidney injury (27.4% vs. 19.8%, adjusted p-value: 0.042). These findings were confirmed in multilevel mixed effect logistic regression adjusted for participating centers. Among patients with diabetes, HbA1c ≥ 53 mmol/mol (7.0%) was predictive of SWI (11.1% vs. 4.8%, p = 0.001).

Conclusions: HbA1c is increased in a significant proportion of patients undergoing elective CABG and these patients are at higher risk of SWI. Less clear is the impact of increased HbA1c on other postoperative outcomes. These results do not support screening of HbA1c in patients without history of diabetes. Preoperative screening of HbA1c is valuable only to identify diabetics at risk of SWI.

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Series: International journal of surgery
ISSN: 1743-9191
ISSN-E: 1743-9159
ISSN-L: 1743-9191
Volume: 53
Pages: 354 - 359
DOI: 10.1016/j.ijsu.2018.04.021
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Copyright information: © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license