Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy
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: |
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, Seite 742 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cardona, Saumeth [VerfasserIn] |
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| Links: |
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| Themen: |
Body mass index |
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| doi: |
10.1016/j.jdiacomp.2017.01.003 |
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| Förderinstitution / Projekttitel: |
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OLC199300355X |
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| 245 | 1 | 0 | |a Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy |
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| 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. 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. | ||
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Surgical outcomes | |
| 650 | 4 | |a Laboratories | |
| 650 | 4 | |a Medicare | |
| 650 | 4 | |a Glucose | |
| 650 | 4 | |a Medicaid | |
| 650 | 4 | |a Clinical trials | |
| 650 | 4 | |a Insulin | |
| 650 | 4 | |a Diabetes | |
| 650 | 4 | |a Heart surgery | |
| 650 | 4 | |a Standard deviation | |
| 650 | 4 | |a Hyperglycemia | |
| 650 | 4 | |a Intensive care | |
| 650 | 4 | |a Cost analysis | |
| 650 | 4 | |a Body mass index | |
| 650 | 4 | |a Pharmacy | |
| 700 | 1 | |a Pasquel, Francisco J |4 oth | |
| 700 | 1 | |a Fayfman, Maya |4 oth | |
| 700 | 1 | |a Peng, Limin |4 oth | |
| 700 | 1 | |a Jacobs, Sol |4 oth | |
| 700 | 1 | |a Vellanki, Priyathama |4 oth | |
| 700 | 1 | |a Weaver, Jeff |4 oth | |
| 700 | 1 | |a Halkos, Michael |4 oth | |
| 700 | 1 | |a Guyton, Robert A |4 oth | |
| 700 | 1 | |a Thourani, Vinod H |4 oth | |
| 700 | 1 | |a Umpierrez, Guillermo E |4 oth | |
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| 773 | 1 | 8 | |g volume:31 |g year:2017 |g number:4 |g pages:742 |
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