H. Wu1, S. Eells2, S. Vangala3, N. Satou1, R. Shemin1, P. Benharash1, J. A. McKinnell2 1David Geffen School Of Medicine At UCLA,Cardiac Surgery,Los Angeles, CA, USA 2Los Angeles Biomedical Research Institute At Harbor–UCLA Medical Center,Infectious Diseases,Torrance, CA, USA 3David Geffen School Of Medicine At UCLA,General Internal Medicine And Health Services Research,Los Angeles, CA, USA
Introduction: Socioeconomic factors, such as access to care, insurance, and medical literacy, are known to play an important role in adequate diabetes control. Patients with poorly controlled diabetes mellitus (DM) (HgbA1c≥7) have higher post-operative mortality and are more likely to suffer complications, including myocardial infarction (MI) and infection following cardiothoracic (CT) surgery. We hypothesize that poor diabetic control among patients undergoing CT surgery is associated with socioeconomic factors.
Methods: We conducted a retrospective cohort investigation of diabetic patients undergoing CT surgery (n=751). Utilizing the UCLA Society of Thoracic Surgeons Adult Cardiac Database, we included patients with recorded HgbA1c value and DM. Bivariate and multivariate logistic regression used to define predictors of poorly controlled diabetes (pre-operative HgbA1c≥7).
Results: Factors associated with pre-operative HgbA1c≥7 in bivariate analysis included lack of insurance (OR 4.75, 95% CI 1.82-12.4, P<0.01), receipt of diabetes therapy (OR 2.01, 95% CI 1.08-3.72, P=0.03), and previous MI (OR 1.71, 95% CI 1.24-2.35, P<0.01). In multivariate analysis when controlling for age, gender, and race/ethnicity, lack of insurance (OR 4.96, 95% CI 1.6-15.4, P<0.01), diabetes therapy (OR 2.27, 95% CI 1.12-4.61, P=0.02), and previous myocardial infarction (OR 1.64, 95% CI 1.15-2.35, P<0.01) was associated with poorly controlled diabetes.
Conclusion: Socioeconomic factors (lack medical insurance) was independently associated with poorly controlled diabetes prior to CT surgery. The only comorbid medical condition in this investigation independently associated with pre-operative HgbA1c was prior MI. In an era of highly effective medical therapy for diabetes, the social determinants of healthcare surpass traditional medical or biologic predictors for effective diabetes control. As poorly controlled diabetes prior to surgery is associated with poor outcomes afterwards, future research is required to understand the interplay of social determinants of health, diabetic control, and outcomes from cardiac surgery.