Mary Pat Hendy

Continuous Insulin Infusion Reduces Infectious Complications in Diabetics Following Coronary Surgery

Abstract  Background: This study was undertaken to evaluate the effects of a continuous insulin infusion protocol on postoperative infection and mortality. Methods: Patients who underwent coronary artery bypass grafting from January 1997 until December 1998 were included in this study (n = 761). A continuous insulin drip protocol (IDP) designed to titrate blood sugar levels to 120–160 mg/dL in the immediate postoperative period was instituted in 1998. Comparisons of diabetic and nondiabetic data before and after initiation of the IDP were made. Results: Of the 761 patients who underwent coronary revascularization, diabetics accounted for 32%. There was no significant difference in age, gender, diabetic status, urgency of operation, or operative time between 1997 and 1998 diabetics and nondiabetics. Overall, wound infections occurred in 3% (23/761) of patients. In 1997, the infection rate was significantly higher in diabetics than nondiabetics (p = 0.0007). After initiation of the IDP in 1998, the infection rate for the diabetic population was reduced to that of the nondiabetic population. There was no significant difference in the mortality rate between 1997 diabetics (4%) and 1998 diabetics (5%) (p = 0.5759) or in the length of stay for 1997 diabetics versus nondiabetics (p = 0.1906). There were no mortalities among patients with wound infections. Conclusion: Initiation of the IDP and the subsequent tight control of blood sugars in the immediate postoperative period proved to reduce the incidence of wound infection in the diabetic population. There was no significant difference in the mortality rate or length of hospitalization.

Changes in Ghrelin Levels Following Bariatric Surgery: Review of the Literature

Obesity is a severe health issue that is a global epidemic. Bariatric surgery is an accepted, popular, and effective therapy for weight loss. Ghrelin, a peptide secreted primarily by the fundus cells of the stomach, has been found to impact body weight by its influence on appetite. Although numerous studies have investigated serum ghrelin levels following bariatric surgery, there is no solid agreement yet as to the direction or magnitude of its change, or even its impact on weight loss. Some studies have found an increase in ghrelin, some have found a decrease, and others have found no change in ghrelin following bariatric surgery. The purpose of this review was to establish the impact of ghrelin changes following bariatric surgery.

Radiofrequency ablation of the porcine liver with complete hepatic vascular occlusion

BackgroundWe studied the effects of radiofrequency ablation, relative to hepatic blood flow, on the volume and shape of the resulting tissue necrosis. The extent of necrosis is directly proportional to the size of the electrode and inversely related to blood flow, which dissipates the heat generated.MethodsTwo areas of necrosis were created in each of eight porcine livers, which were assigned to four groups according to blood flow occlusion: no occlusion, occlusion of the hepatic artery and portal vein, occlusion of the hepatic veins, and complete hepatic vascular occlusion. After 25 minutes of liver reperfusion, the animals were euthanized, and the livers were examined.ResultsComplete vascular occlusion resulted in the greatest are of necrosis (28.6±3.4 cm3). followed by occlusion of the hepatic artery and portal vein (19.2±5.9 cm3), occlusion of hepatic veins (14.4±2.6 cm3), and no occlusion (4.9±1.5 cm3). The volume of the necrotic areas created during complete vascular occlusion were significantly greater than those created with no occlusion, as well as those created with only the hepatic artery and portal vein occluded (P<.05).ConclusionsComplete vascular occlusion, combined with radiofrequency ablation, increases the volume of necrosis and creates a more spherical ablative area.

Coronary artery bypass grafting in patients with dialysis-dependent end stage renal disease: a prospective, nested case-control study.

Abstract  Objective: To assess if coronary artery bypass grafting (CABG) patients with dialysis‐dependent end stage renal disease (ESRD) experience greater intraoperative and postoperative morbidity and mortality compared to CABG patients without ESRD. Methods: We conducted a nested case–control study from an 8‐year hospitalization cohort in which data were collected prospectively. Inclusion criteria included CABG surgery and age greater than 18 years. Cases were patients with dialysis dependent ESRD (N = 28) and controls were patients without ESRD (N = 84). Cases were matched to controls 1:3 on age, gender, tobacco history, and New York Heart Association Functional Class. The outcomes of interest were mortality, intensive care unit length of stay, total length of hospitalization, time on the ventilator, wound complications, pulmonary complications, neurological complications, gastrointestinal complications, arrhythmia, and intraoperative complications. Using logistic regression we controlled for 13 potential confounding variables. Results: There were no significant differences between the groups with the exception of total length of hospitalization. Patients with dialysis‐dependent ESRD had a significantly longer total hospitalization stay (21%) than patients without ESRD. There were no significant differences for the remaining nine outcomes of interest, including perioperative morbidity or mortality. Conclusion: Intraoperative and postoperative morbidity and mortality for CABG were not increased for patients with dialysis‐dependent ESRD compared to patients without ESRD. However, patients on dialysis undergoing CABG experienced a greater length of hospitalization than patients undergoing CABG who were not on dialysis.

Autologous blood transfusion in elective cardiac valve operations.

Abstract  Background and Aim of Study: The aim of this study was to detect any outcome differences between patients who donated autologous blood versus nondonors undergoing nonemergent cardiac valve surgery. Of further interest was whether autologous donors required less allogeneic blood products overall than patients who did not donate. Methods: We conducted a nested case‐control study in which data were collected prospectively on 225 variables. Cases underwent nonemergent, cardiac valve surgery and donated autologous blood products (n = 40). Controls also had nonemergent, cardiac valve surgery but did not donate autologous blood products (n = 120). Cases were matched to controls 1:3 on age (±3 years), gender, and New York Heart Association Functional Classification. We controlled for 12 potential confounding variables and examined 17 outcomes of interest. To generate the unadjusted risks of each outcome, chi‐square and t‐tests were performed comparing cases and controls to each outcome of interest. Then logistic regression analysis investigated the adjusted risk between cases and controls and for the outcomes of interest, each controlling for the potential confounding variables. Results: There were no significant differences between the cases and controls for 11 of the 12 possible confounding variables. Controls had significantly more chronic obstructive pulmonary disorder. There were no significant differences between cases and controls for 13 of the 17 outcomes of interest. Autologous blood donors received more total packed red blood cells (PRBCs) (p = 0.0373) and more total fresh frozen plasma than controls (p = 0.0002). Fewer autologous blood donors required allogeneic packed red blood cell transfusion (p = 0.0134), and the total length of stay was shorter for autologous donors (p = 0.0782). Conclusion: Four of the 17 outcomes of interest were different for patients who donated autologous blood versus those who did not. Our experience demonstrated that elective cardiac valve surgery can safely reduce (by 18.3%) the need for allogeneic PRBCs by utilizing preoperative autologous blood donation.