Preliminary Outcomes of Perioperative Glucose Management in Elective Surgical Patients at a Community Hospital

Author(s):
Abdel Salous; Karen Sweeney; Chris D’Adamo; Vanita Ahuja, MD

Background:

Perioperative hyperglycemia was identified as a common risk factor for increased post-operative morbidity, including surgical site infections, in patients with diabetes mellitus (DM) at Sinai Hospital of Baltimore.

Hypothesis:

Better periperative glycemic control will decrease post-surgical complications, including 30 day readmission and surgical site infections.

Methods:

A multidisciplinary team was assembled and educational seminars were held and a standardized multi-phasic protocol was created, streamlined, and approved for the management of preoperative patients with DM .  Perioperative glucose management was assessed and treated at multiple phases and by multiple providers using a unified electronic medical record order set platform. Continuous refinement of the protocol was achieved by incorporating feedback from care providers and team members. Data was collected from the ACS NSQIP database prior to and following the intervention.

Results:

Data was collected and reviewed for a total 198 diabetic patients (108 pre-intervention and 90 post-intervention) who underwent elective general surgical procedures.   Our preliminary data analysis showed pre-intervention glucose range was 35-419 while post-intervention range was 65-317. The mean pre-op glucose was 148.6 in the pre-intervention group and 144 for the post-intervention group. The post-op glucose mean was 181.8 in the pre-intervention group and 185.2 in the post-intervention group. None of these differences reached statistical significance in t-tests (p>0.05). Surprisingly, the post-intervention group had a significantly longer duration of surgery (8.1 days vs 5.4 days; p=0.0173) and significantly longer duration of surgery (277.7 minutes vs. 218.9 minutes; p=0.0063).  Readmission within 30 days decreased from 16.7% to 12.2% following the intervention (p=0.27).

Conclusions:

A novel multidisciplinary protocol was designed and implemented to monitor perioperative hyperglycemia in elective surgical patients. While the short-term outcomes (blood glucose measurements) were not significant, potentially secondary to increased duration of surgery and duration of stay, the long-term outcome measures showed improvement (decreased readmission). Future efforts will include formally assessing intervention compliance and covariate-adjusted regression analyses adjusting for factors (comborbidity, length of surgery, etc.) that may be confounding the effectiveness of the intervention.