Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy

Background: The financial impact of intensive (blood glucose [BG] 100-140 mg/di [5.5-7.8 mM] vs. conservative (141-180 mg/dl (7.9-10.0 mM) 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 +/- 14 mg/dl-(7.2 +/- 0.8 mM) vs. 151.6 +/- 17 mg/dl (8.4 +/- 0.8 mM, p < 0.001), a nonsignificant reduction in the median length of stay (LOS, 7.9 vs. 8.5 days, 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 (10.7 days vs. 6.7 days, 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 [SG 100-140 mg/dl (5.5-7.8 mM)] in patients undergoing CABG resulted in significant reductions in hospitalization costs and resource utilization compared to patients treated with conservative [BG 141-180 mg/dl (7.9-10.0 mM)] glucose control. (C) 2017 Elsevier Inc. All rights reserved.