JS. Auerbach, A. Alnajar, SS. Patel, HB. Gershengorn, J. Lamelas, D. Perez, OD. Aljure, TD. Ferreira, LA. Gonzalez, et al. (2025). Retrospective Chart Review of Euglycemic Diabetic Ketoacidosis Rates and Outcomes Postimplementation of Sodium Glucose Cotransporter 2 Inhibitor Use Stoppage 5 Days Before Open Heart Surgery. Journal of cardiothoracic and vascular anesthesia, 39(6), 1441-1450. https://doi.org/10.1053/j.jvca.2025.02.030

PubMed 40090790

[Abstract]
OBJECTIVES: Outcomes of stopping sodium-glucose cotransporter 2 inhibitors (SGLT2i) 5 days before open heart surgery (euglycemic diabetic ketoacidosis [eDKA] rate, mortality, infection, hospital, and cardiovascular intensive care unit [CVICU] length of stay [LOS]).

DESIGN: Retrospective study.

SETTING: Academic university hospital.

PARTICIPANTS: Adult open heart surgery patients.

EXPOSURES: Patients on SGLT2i who stopped medications 5 days before open heart surgery versus non-SGLT2i-using patients.

MEASUREMENTS AND MAIN RESULTS: We evaluated patients who were told to stop SGLT2i 5 days before receiving open heart surgery for eDKA development within 24 hours of hospital admission (12/14/2022 to 10/25/2023). Non-eDKA outcomes were compared between SGLT2i users and non-users using Wilcoxon rank sum and Chi-square testing as appropriate. Of 540 open heart surgery patients, 48 (8.9%) were prescribed SGLT2i's before surgery; of these, 0 (0%) developed eDKA within 24 hours of hospital admission. Hospital LOS was statistically longer for patients with SGLT2i use (median [interquartile range]: 4 [4-5] v 4 [3-6] days, p = 0.003; mean [standard deviation]: 4 [3] v 5 [2], p = 0.03). We found no significant difference between patients with and without SGLT2i use in CVICU LOS (median [interquartile range]: 1.67 [0.95-2.09] v 1.17 [0.96-1.88] days, p = 0.14), in-hospital mortality (2.1% [1] v 0.6% [3], p = 0.3), or sternal infections (0 [0.0%] v 2 [0.4%], p > 0.9).

CONCLUSION: Postoperative eDKA was absent in SGLT2i patients told to stop medications 5 days before open heart surgery. LOS and infection and mortality rates appeared similar between the two cohorts. Stopping SGLT2i medications 5 days before open heart surgery appears safe.