Impact of Intraoperative Hyperglycemia on Postoperative Complications in Adult Cardiac Surgery: A Multi-Institutional Analysis.
Document Type
Article
Publication Date
10-2026
Publication Title
Journal of Thoracic and Cardiovascular Surgery
Abstract
BACKGROUND: Perioperative hyperglycemia is common in cardiac surgery and is associated with adverse outcomes; however, optimal intraoperative glucose targets remain incompletely defined. We evaluated the association between intraoperative glycemic control and postoperative outcomes and assessed the impact of a prospectively implemented statewide quality improvement (QI) initiative.
METHODS: Patients undergoing cardiac surgery with cardiopulmonary bypass from 2020 to 2024 within a statewide collaborative were retrospectively stratified by peak intraoperative glucose level (< 180 mg/dL versus ≥180 mg/dL) for analysis. Primary outcomes included infectious complications, acute kidney injury (AKI), renal failure, stroke, and composite morbidity. Multivariable mixed-effects logistic regression models adjusted for patient, operative, and institutional factors. Interrupted time series analysis evaluated changes in glycemic control following QI implementation.
RESULTS: Among 22,747 patients, 74.2% achieved peak intraoperative glucose < 180 mg/dL. Patients with peak glucose < 180 mg/dL had lower rates of composite infection (4.75% vs 7.64%), AKI (23.46% vs 28.85%), and operative mortality (1.73% vs 3.31%) (all p< 0.001). After adjustment, peak glucose < 180 mg/dL remained associated with lower odds of surgical site infection (OR 0.81), sepsis (OR 0.61), pneumonia (OR 0.80), AKI (OR 0.86), renal failure (OR 0.79), and composite complications (OR 0.86); stroke was not associated. Following QI implementation, achievement of peak glucose < 180 mg/dL increased from 66.9% to 88.2%, with a significant improvement in temporal trends (p< 0.001).
CONCLUSIONS: Peak intraoperative glucose < 180 mg/dL was independently associated with improved infectious and renal postoperative outcomes after cardiac surgery. A statewide QI initiative significantly improved glycemic control, supporting adoption of standardized intraoperative glucose management protocols.
Recommended Citation
Disharoon M, Fruth C, He C, Clark MJ, Nieter D, Sturmer D, et al. [Timek TA]. Impact of intraoperative hyperglycemia on postoperative complications in adult cardiac surgery: A multi-institutional analysis. J Thorac Cardiovasc Surg. 2026. doi: 10.1016/j.jtcvs.2026.09.025. PMID: 42849659.
DOI
10.1016/j.jtcvs.2026.09.025
ISSN
1097-685X
PubMed ID
42849659