Providence Heart and Vascular Institute - eCardioVascular Beat
Diabetes and surgery: Controlling blood sugar
saves lives
Anthony P. Furnary, M.D.
Cardiothoracic surgery, Providence St. Vincent Medical Center
Starr-Wood Group
Decades of research at Providence Heart and Vascular Institute has led to dramatically improved outcomes for patients with diabetes who require cardiac surgery. The improved outcomes are the result of The Portland Protocol – a pioneering treatment developed at PHVI that controls blood sugar levels of diabetic surgery patients through strict intravenous insulin infusion.
Diabetes afflicts 7 percent of the U.S. population, yet people with diabetes make up one-third of all patients who need open-heart surgery, and they face a much higher mortality rate. “Providence’s cardiac surgical teams are recognized as worldwide leaders in cardiac surgery on patients with diabetes due to their ground-breaking research known as The Portland Diabetes Project.”Because patients with diabetes are especially prone to develop coronary artery disease, 54 percent of patients with diabetes end up requiring treatment for this disease during their lifetime. As such, more than 31 percent of all open-heart surgery patients have diabetes.
According to the national Society of Thoracic Surgeons, when patients with diabetes undergo cardiac surgery their postoperative morbidity and mortality rates are respectively 10 and 2.5 times higher than similar patients without diabetes. This fact holds true at other cardiac surgery centers around the country, but it is distinctly not the case at Providence St. Vincent Medical Center.
Providence’s cardiac surgical teams are recognized as worldwide leaders in cardiac surgery on patients with diabetes due to their ground-breaking research known as The Portland Diabetes Project.
This project, initiated in 1992 by Jeanne Zerr, R.N., M.A., a cardiac surgery research nurse, found links between hyperglycemia and adverse outcomes in cardiac surgery patients with diabetes. Hyperglycemia in the perioperative period has since been found to independently increase the risks of death, cardiac arrhythmias, heart failure, infections, transfusions, renal failure and length of stay.
The early discovery that hyperglycemia was the primary causal factor for postoperative wound infections was the impetus behind The Portland Protocol – an internationally acclaimed intravenous insulin infusion protocol developed by Providence St. Vincent endocrinologist Stephen Bookin, M.D.
Working with researchers at the Providence Heart and Vascular Institute-affiliated medical data research center, Dr. Bookin and our surgeons have implemented, honed and extended the use of this protocol. It is now universally used in cardiac surgery patients for three full postoperative days, even on patients who have already left the ICU. This nursing-intensive process, and its use beyond the confines of the ICU, has vastly improved the perioperative outcomes of the cardiac-diabetes patient, and has set PSVMC apart in the world of diabetes-cardiac surgery.
From 1999 to 2006, the mortality rate for patients with diabetes undergoing coronary bypass (CABG) surgery at PSVMC was 0.9 percent – four times lower than the national mortality rate of 3.6 percent. During the same period the surgical infection rate at PSVMC was 0.3 percent, nearly 10 times lower than results published for such patients elsewhere.
Put in human terms, one out of every 28 diabetes CABG patients does not survive his or her hospital stay elsewhere. Yet 110 out of 111 such patients leave PSVMC alive and well. All the while the incidence of arrhythmias, heart failure, transfusions, renal failure and length of stay are markedly reduced.
The cardiac surgery team at Providence St. Vincent Medical Center has dedicated itself to producing the best care for all of its patients. That dedication led to the discovery and development of the concept of tight glycemic control, which has now become one of the most talked about paradigm shifts in medicine.
The Portland Diabetes Project has shown that three days of insulin infusions independently reduce mortality by 68 percent and independently reduce infectious complications by 77 percent in cardiac surgery patients. Not since the discovery and clinical application of penicillin has there been such a powerful nonsurgical intervention that so positively alters surgical outcomes.
Visit the Web for more information about The Portland Diabetes Project or call Eric Johnson, clinical research supervisor, at 503-216-2075.
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