Elucidation of the novel role of ethnicity and diabetes in poorer outcomes after cardiac surgery in a multiethnic Southeast Asian cohort

Background Although diabetes is associated with ethnicity and worse cardiac surgery outcomes, no research has been done to study the effect of both diabetes and ethnicity on cardiac surgery outcomes in a multiethnic Southeast Asian cohort. Hence, this study aimed to delineate the association of ethnicity on outcomes after cardiac surgery among diabetics in a multiethnic Southeast Asian population. Methods Perioperative data from 3008 adult patients undergoing elective cardiac surgery from 2008 to 2011 at the two main heart centers in Singapore was analyzed prospectively, and confirmatory analysis was conducted with the generalized structural equation model. Results Diabetes was significantly associated with postoperative acute kidney injury (AKI) and postoperative hyperglycemia. Postoperative AKI, Malay ethnicity, and blood transfusion were associated with postoperative dialysis. Postoperative AKI and blood transfusion were also associated with postoperative arrhythmias. In turn, postoperative dialysis and arrhythmias increased the odds of 30‐day mortality by 7.7‐ and 18‐fold, respectively. Conclusions This study identified that diabetes is directly associated with postoperative hyperglycemia and AKI, and indirectly associated with arrhythmias and 30‐day mortality. Further, we showed that ethnicity not only affects the prevalence of diabetes, but also postoperative diabetes‐related outcomes. 摘要 背景 尽管糖尿病与种族及心脏手术后不良结局有关, 但是目前还没有研究调查在多种族的东南亚人群中, 糖尿病与种族对心脏手术结局的影响。因此, 本研究旨在阐明在多种族的东南亚人群中, 种族与糖尿病患者心脏手术后结局的相关性。 方法 对2008年至2011年间在新加坡两个主要心脏中心接受择期心脏手术的3008例成年患者的围手术期资料进行前瞻性分析, 并用广义结构方程模型进行验证性分析。 结果 糖尿病与术后急性肾损伤(acute kidney injury, AKI)及术后高血糖显著相关。术后AKI、马来族以及输血均与术后透析相关。术后AKI和输血还与术后心律失常相关。随之而来, 术后透析和心律失常导致30天死亡率分别增加了7.7倍与18倍。 结论 本研究发现糖尿病与术后高血糖及AKI直接相关, 与心律失常和30天死亡率间接相关。此外, 我们发现种族不仅影响糖尿病的患病率, 也影响术后糖尿病相关的结局。 Highlights In this study, Indian and Malay ethnicities were associated with preoperative diabetes, but their odds of early death differ. Diabetes was directly associated with postoperative hyperglycemia and acute kidney injury, and indirectly associated with arrhythmia and early death. Ethnicity not only affects the prevalence of diabetes, but also postoperative diabetes‐related outcomes.