Impact of Intraoperative Hyperglycemia on Postoperative Complications in Adult Cardiac Surgery: A Multi-Institutional Analysis

Document Type

Conference Proceeding

Publication Date

5-2026

Publication Title

Journal of Thoracic and Cardiovascular Surgery

Abstract

Purpose: Perioperative hyperglycemia increases the risk of short-term complications following cardiac surgery. In 2022, a statewide quality collaborative implemented a quality improvement (QI) initiative to improve intraoperative glucose management. The objective of this study was to assess the impact of this initiative on patient outcomes. Methods: The study included patients who underwent CABG between Jan. 2020 and Sept. 2024 at 34 centers. Data compiled from The STS National Database was used and patients were stratified by peak intraoperative glucose levels (< 180 mg/dL vs>180 mg/dL). Outcomes included individual infections, a composite infection measure, stroke, AKI or failure, and a composite of all six complications. Risk-adjusted outcomes were analyzed using mixed-effects logistic regression including demographic, comorbidity, and surgical factors. Hospital and surgeon were included as random effects. To evaluate the effect of the intraoperative glucose management initiative launched in the second half of 2022, an interrupted time series model was conducted using semi-annual time intervals. Results: Of the 22,747 patients included, 74% had intraoperative glucose levels< 180 mg/dL. Following implementation of the initiative, the proportion of patients with a peak glucose < 180 increased over time from 66.9% to 88.2%(Figure). Compared with those with a peak intraoperative glucose >180 mg/dL, patients with glucose< 180 were less likely to have diabetes (41.9% vs 69.6%), were older, and were less often female, Black or Asian. Patients with an intraoperative glucose< 180 mg/dL also had fewer comorbidities, including peripheral vascular disease and chronic lung disease. Following operation, patients with an intraoperative glucose< 180 had lower unadjusted rates of infection and AKI or failure, but no difference in stroke incidence. After risk adjustment, peak intraoperative glucose < 180 was independently associated with lower odds of infection (ORadj 0.79), AKI(0.86), and composite complications(0.86), but not stroke. The QI initiative resulted in 13% higher semi-annual increase in peak intraoperative glucose< 180 mg/dL, with the odds ratio increasing 1.03 to 1.16. Conclusions: A statewide initiative improved intraoperative glucose during CABG. Glucose management with a level of< 180 was independently associated with less infections and kidney injury. Adoption of intraoperative glycemic protocols with levels of< 180 may reduce complications.

Volume

171

Issue

4 Suppl 1

First Page

S88

Last Page

S88

Comments

American Association for Thoracic Surgery (AATS) 106th Annual Meeting, May 2-5, 2026, Chicago, IL

DOI

10.1016/j.jtcvs.2026.03.194

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