Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy
Copyright © 2017 Elsevier Inc. All rights reserved..
BACKGROUND: The financial impact of intensive (blood glucose [BG] 100-140mg/dl [5.5-7.8mM] vs. conservative (141-180mg/dl (7.9-10.0mM) glucose control in the ICU in patients, with and without diabetes, undergoing coronary artery bypass graft (CABG) surgery is not known.
METHODS: This post-hoc cost analysis determined differences in hospitalization costs, resource utilization and perioperative complications in 288 CABG patients with diabetes (n=143) and without diabetes (n=145), randomized to intensive (n=143) and conservative (n=145) glucose control.
RESULTS: Intensive glucose control resulted in lower BG (131.4±14mg/dl-(7.2±0.8mM) vs. 151.6±17mg/dl (8.4±0.8mM, p<0.001), a nonsignificant reduction in the median length of stay (LOS, 7.9 vs. 8.5days, p=0.17) and in a composite of perioperative complications including wound infection, bacteremia, acute renal and respiratory failure, major cardiovascular events (42% vs 52%, p=0.10) compared to conservative control. Median hospitalization costs were lower in the intensive group ($39,366 vs. $42,141, p=0.040), with a total cost savings of $3654 (95% CI: $1780-$3723), than conservative control. Resource utilization for radiology (p=0.008), laboratory (p=0.014), consultation service (p=0.013), and ICU utilization (p=0.007) were also lower in the intensive group. Compared to patients without perioperative complications, those with complications had longer hospital length of stay (10.7days vs. 6.7days, p<0.001), higher total hospitalization cost ($48,299 vs. $32,675, p<0.001), and higher resource utilization units (2745 vs. 1710, p<0.001).
CONCLUSION: Intensive glycemic control [BG 100-140mg/dl (5.5-7.8mM)] in patients undergoing CABG resulted in significant reductions in hospitalization costs and resource utilization compared to patients treated with conservative [BG 141-180mg/dl (7.9-10.0mM)] glucose control.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2017 |
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| Erschienen: |
2017 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:31 |
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| Enthalten in: |
Journal of diabetes and its complications - 31(2017), 4 vom: 01. Apr., Seite 742-747 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cardona, Saumeth [VerfasserIn] |
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| Links: |
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| Themen: |
Algorithm |
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| Anmerkungen: |
Date Completed 19.03.2018 Date Revised 19.03.2018 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.jdiacomp.2017.01.003 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM268660123 |
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| 100 | 1 | |a Cardona, Saumeth |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy |
| 264 | 1 | |c 2017 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 19.03.2018 | ||
| 500 | |a Date Revised 19.03.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2017 Elsevier Inc. All rights reserved. | ||
| 520 | |a BACKGROUND: The financial impact of intensive (blood glucose [BG] 100-140mg/dl [5.5-7.8mM] vs. conservative (141-180mg/dl (7.9-10.0mM) glucose control in the ICU in patients, with and without diabetes, undergoing coronary artery bypass graft (CABG) surgery is not known | ||
| 520 | |a METHODS: This post-hoc cost analysis determined differences in hospitalization costs, resource utilization and perioperative complications in 288 CABG patients with diabetes (n=143) and without diabetes (n=145), randomized to intensive (n=143) and conservative (n=145) glucose control | ||
| 520 | |a RESULTS: Intensive glucose control resulted in lower BG (131.4±14mg/dl-(7.2±0.8mM) vs. 151.6±17mg/dl (8.4±0.8mM, p<0.001), a nonsignificant reduction in the median length of stay (LOS, 7.9 vs. 8.5days, p=0.17) and in a composite of perioperative complications including wound infection, bacteremia, acute renal and respiratory failure, major cardiovascular events (42% vs 52%, p=0.10) compared to conservative control. Median hospitalization costs were lower in the intensive group ($39,366 vs. $42,141, p=0.040), with a total cost savings of $3654 (95% CI: $1780-$3723), than conservative control. Resource utilization for radiology (p=0.008), laboratory (p=0.014), consultation service (p=0.013), and ICU utilization (p=0.007) were also lower in the intensive group. Compared to patients without perioperative complications, those with complications had longer hospital length of stay (10.7days vs. 6.7days, p<0.001), higher total hospitalization cost ($48,299 vs. $32,675, p<0.001), and higher resource utilization units (2745 vs. 1710, p<0.001) | ||
| 520 | |a CONCLUSION: Intensive glycemic control [BG 100-140mg/dl (5.5-7.8mM)] in patients undergoing CABG resulted in significant reductions in hospitalization costs and resource utilization compared to patients treated with conservative [BG 141-180mg/dl (7.9-10.0mM)] glucose control | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Algorithm | |
| 650 | 4 | |a CABG | |
| 650 | 4 | |a Diabetes mellitus | |
| 650 | 4 | |a Health economics | |
| 650 | 4 | |a Hyperglycemia | |
| 650 | 4 | |a Surgery complications | |
| 650 | 7 | |a Blood Glucose |2 NLM | |
| 650 | 7 | |a Hypoglycemic Agents |2 NLM | |
| 650 | 7 | |a Insulin |2 NLM | |
| 700 | 1 | |a Pasquel, Francisco J |e verfasserin |4 aut | |
| 700 | 1 | |a Fayfman, Maya |e verfasserin |4 aut | |
| 700 | 1 | |a Peng, Limin |e verfasserin |4 aut | |
| 700 | 1 | |a Jacobs, Sol |e verfasserin |4 aut | |
| 700 | 1 | |a Vellanki, Priyathama |e verfasserin |4 aut | |
| 700 | 1 | |a Weaver, Jeff |e verfasserin |4 aut | |
| 700 | 1 | |a Halkos, Michael |e verfasserin |4 aut | |
| 700 | 1 | |a Guyton, Robert A |e verfasserin |4 aut | |
| 700 | 1 | |a Thourani, Vinod H |e verfasserin |4 aut | |
| 700 | 1 | |a Umpierrez, Guillermo E |e verfasserin |4 aut | |
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| 773 | 1 | 8 | |g volume:31 |g year:2017 |g number:4 |g day:01 |g month:04 |g pages:742-747 |
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