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Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy.
- Source :
-
Journal of diabetes and its complications [J Diabetes Complications] 2017 Apr; Vol. 31 (4), pp. 742-747. Date of Electronic Publication: 2017 Jan 20. - Publication Year :
- 2017
-
Abstract
- 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.<br />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.<br />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).<br />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.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Academic Medical Centers
Aged
Blood Glucose analysis
Coronary Artery Bypass economics
Coronary Artery Disease complications
Coronary Artery Disease economics
Cost Savings
Costs and Cost Analysis
Diabetes Mellitus blood
Diabetes Mellitus economics
Diabetic Angiopathies complications
Diabetic Angiopathies economics
Diabetic Cardiomyopathies complications
Diabetic Cardiomyopathies economics
Diabetic Cardiomyopathies surgery
Female
Hospital Costs
Humans
Hypoglycemic Agents administration & dosage
Hypoglycemic Agents adverse effects
Hypoglycemic Agents economics
Insulin administration & dosage
Insulin adverse effects
Insulin economics
Insulin Infusion Systems adverse effects
Insulin Infusion Systems economics
Length of Stay
Male
Middle Aged
Postoperative Complications economics
Postoperative Complications prevention & control
Postoperative Complications therapy
Treatment Outcome
Coronary Artery Bypass adverse effects
Coronary Artery Disease surgery
Diabetes Mellitus drug therapy
Diabetic Angiopathies surgery
Drug Monitoring
Hypoglycemic Agents therapeutic use
Insulin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1873-460X
- Volume :
- 31
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of diabetes and its complications
- Publication Type :
- Academic Journal
- Accession number :
- 28161384
- Full Text :
- https://doi.org/10.1016/j.jdiacomp.2017.01.003