2192-P: Temporal Trends in Outcomes after Cardiac Surgery: Diverging Infection Rates by Diabetes Status

Introduction and Objective: Diabetes is linked to poor outcomes after cardiac surgery (CS). Whether advances in diabetes care have narrowed outcome gaps between people with and without diabetes over time remains unclear. We aimed to compare temporal trends in mortality and complications after CS in people with vs. without diabetes. Methods: We analyzed 11,118 adults who had CS from 2005 to 2019. Outcomes were 30-day and 1-year mortality, total complications, and infections. Cox regression assessed time-outcome interactions with diabetes, adjusting for comorbidities and surgical factors. Results: Over 15 years, the proportion of patients with diabetes increased (23% to 25%), and diabetics were more often male (76% vs 70%) than nondiabetics (all P<0.01). Use of oral antidiabetics increased (11% to 16%, P<0.001), while insulin use remained stable (8%). Overall, 30-day and 1-year mortality and total complications declined similarly in both groups (Fig A-C). However, infections decreased over time in people with diabetes but increased in nondiabetics (interaction P<0.001; Fig D). Diabetes was independently linked to 1-year mortality (HR 1.62, P=0.007) and total complications (RR 1.07, P=0.01), but showed no time interaction. Conclusion: Despite improvements in CS outcomes, people with diabetes remain at higher risk. Temporal reductions in infection rates among people with diabetes suggest successful diabetes-specific perioperative advances warrant further investigation.