Recent metformin ingestion does not increase in-hospital morbidity or mortality after cardiac surgery

被引:66
作者
Duncan, Andra I.
Koch, Colleen G.
Xu, Meng
Manlapaz, Mariel
Batdorf, Brian
Pitas, Grzegorz
Starr, Norman
机构
[1] Cleveland Clin Fdn, Dept Cardiothorac Anesthesia, Cleveland, OH 44195 USA
[2] Cleveland Clin Fdn, Dept Quantitat Hlth Sci, Cleveland, OH 44195 USA
关键词
D O I
10.1213/01.ane.0000242532.42656.e7
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
BACKGROUND: Perioperative treatment of type 2 diabetes with metformin, an oral hypoglycemic drug, is thought to increase the risk of life-threatening postoperative lactic acidosis. In contrast, metformin improves serum glucose control and has beneficial cardiovascular effects, which may decrease the risk of adverse outcomes. In this investigation we sought to determine the influence of metformin treatment on mortality and morbidity compared with treatment with other oral hypoglycemic drugs in diabetic patients undergoing cardiac surgery. METHODS: In this retrospective investigation, 1284 diabetic patients, with recent oral hypoglycemc ingestion (presumed to be 8-24 h preoperatively), underwent cardiac surgery from 1994-2004. Propensity scores were calculated from a logistic model which included baseline characteristics and perioperative variables. Four-undred-forty-three (85%) of the metformin-treated patients were matched on nearest propensity score using greedy matching techniques with 443 nonmetformin-treated patients. Postoperative outcomes were compared between matched metformin- and nonmetformin-treated patients. RESULTS: In-hospital mortality, cardiac, renal, and neurologic morbidities were similar between groups. Metformin-treated patients had less postoperative prolonged tracheal intubation [OR (95% CI), 0.3 (0.1, 0.7), P = 0.003], infection [0.2 (0.1, 0.7), P = 0.007] and overall morbidities [0.4 (0.2, 0.8), P = 0.005]. CONCLUSIONS: These data suggest that recent metformin ingestion is not associated with increased risk of adverse outcome in cardiac surgical patients. Alternatively, metformin treatment may have beneficial effects.
引用
收藏
页码:42 / 50
页数:9
相关论文
共 23 条
[1]   DIABETES AND SURGERY [J].
ALBERTI, KGMM .
ANESTHESIOLOGY, 1991, 74 (02) :209-211
[2]   Drug therapy - Metformin [J].
Bailey, CJ ;
Turner, RC .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 334 (09) :574-579
[3]   Lactic acidosis rates in type 2 diabetes [J].
Brown, JB ;
Pedula, K ;
Barzilay, J ;
Herson, MK ;
Latare, P .
DIABETES CARE, 1998, 21 (10) :1659-1663
[4]   Evaluation of prescribing practices - Risk of lactic acidosis with metformin therapy [J].
Calabrese, AT ;
Coley, KC ;
DaPos, SV ;
Swanson, D ;
Rao, RH .
ARCHIVES OF INTERNAL MEDICINE, 2002, 162 (04) :434-437
[5]   EFFICACY OF METFORMIN IN PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS [J].
DEFRONZO, RA ;
GOODMAN, AM ;
ABELOVE, W ;
REID, E ;
PITA, J ;
CALLAHAN, M ;
JOHNSON, D ;
PELAYO, E ;
PUGH, J ;
SHANK, M ;
GARZA, P ;
HAAG, B ;
KORFF, J ;
ANGELO, A ;
IZENSTEIN, B ;
VANDERLEEDEN, M ;
CATHCART, H ;
TIERNEY, M ;
BIGGS, D ;
KARAM, J ;
NOLTE, M ;
GAVIN, L ;
ELDER, MA ;
CORBOY, J ;
THWAITE, D ;
WONG, S ;
DAVIDSON, M ;
PETERS, A ;
DUNCAN, T ;
KERCHER, S ;
FISCHER, J ;
KIPNES, M ;
RADNICK, BJ ;
ROURA, M ;
ROQUE, J ;
MONTGOMERY, C ;
COLLUM, P ;
RUST, M ;
POHL, S ;
PFEIFER, M ;
ALLWEISS, P ;
LEICHTER, S ;
LEACH, P ;
GALLINA, D ;
MUSEY, V ;
BERKOWITZ, K ;
EASTMAN, R ;
TAYLOR, T ;
DELAPENA, MS ;
ZAWADSKI, J .
NEW ENGLAND JOURNAL OF MEDICINE, 1995, 333 (09) :541-549
[6]   PROGNOSTIC MODELS AND THE PROPENSITY SCORE [J].
DRAKE, C ;
FISHER, L .
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY, 1995, 24 (01) :183-187
[7]  
Furnary Anthony P, 2004, Endocr Pract, V10 Suppl 2, P21
[8]   STUDY OF THE EFFECT OF METFORMIN ON PLATELET-AGGREGATION IN INSULIN-DEPENDENT DIABETICS [J].
GIN, H ;
FREYBURGER, G ;
BOISSEAU, M ;
AUBERTIN, J .
DIABETES RESEARCH AND CLINICAL PRACTICE, 1989, 6 (01) :61-67
[9]   Bicarbonate haemodialysis as a treatment of metformin overdose [J].
Heaney, D ;
Majid, A ;
Junor, B .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 1997, 12 (05) :1046-1047
[10]   STRATIFICATION OF MORBIDITY AND MORTALITY OUTCOME BY PREOPERATIVE RISK-FACTORS IN CORONARY-ARTERY BYPASS PATIENTS - A CLINICAL SEVERITY SCORE [J].
HIGGINS, TL ;
ESTAFANOUS, FG ;
LOOP, FD ;
BECK, GJ ;
BLUM, JM ;
PARANANDI, L .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1992, 267 (17) :2344-2348