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CARDIOVASCULAR ANESTHESIA

Recent Metformin Ingestion Does Not Increase In-Hospital Morbidity or Mortality After Cardiac Surgery

Andra I. Duncan, MD^*, Colleen G. Koch, MD, MS^*, Meng Xu, MS, Mariel Manlapaz, MD^*, Brian Batdorf, DO, PhD^*, Grzegorz Pitas, MD^*, and Norman Starr, MD^*

From the *Departments of Cardiothoracic Anesthesia and Quantitative Health Sciences, The Cleveland Clinic Foundation, Cleveland, Ohio.

Address correspondence to Andra Ibrahim Duncan, MD, Department of Cardiothoracic Anesthesia, Cleveland Clinic Foundation, 9500 Euclid Avenue/G30, Cleveland, OH 44195. Address e-mail to: duncana{at}ccf.org. Reprints will not be available from the author.

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 hypoglycemic 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-hundred-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.

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