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Detection and Management of Perioperative Hyperglycemia at a Tertiary Cancer Center
Ist Teil von
Annals of surgical oncology, 2024-05, Vol.31 (5), p.3017-3023
Ort / Verlag
Cham: Springer International Publishing
Erscheinungsjahr
2024
Quelle
MEDLINE
Beschreibungen/Notizen
Introduction
To improve the detection and management of perioperative hyperglycemia at our tertiary cancer center, we implemented a glycemic control quality improvement initiative. The primary goal was to decrease the percentage of diabetic patients with median postoperative glucose levels > 180 mg/dL during hospitalization by 15% within 2 years.
Methods
A multidisciplinary team standardized preoperative screening, preoperative, intraoperative, and postoperative hyperglycemia management. We included all patients undergoing nonemergent inpatient and outpatient operations. We used a
t
test, rank sum, chi-square, or Fisher’s exact test to assess differences in outcomes between patients at baseline (BL) (10/2018–4/2019), during the first phase (P1) (10/2019–4/2020), second phase (P2) (5/2020–12/2020), and maintenance phase (M) (1/2021–10/2022).
Results
The analysis included 9891 BL surgical patients (1470 with diabetes), 8815 P1 patients (1233 with diabetes), 10,401 P2 patients (1531 with diabetes) and 30,410 M patients (4265 with diabetes). The percentage of diabetic patients with median glucose levels >180 mg/dL during hospitalization decreased 32% during the initiative (BL, 20.1%; P1, 16.9%; P2, 12.1%; M, 13.7% [
P
< .001]). We also saw reductions in the percentages of diabetic patients with median glucose levels >180 mg/dL intraoperatively (BL, 34.0%; P1, 26.6%; P2, 23.9%; M, 20.3% [
P
< .001]) and in the postanesthesia care unit (BL, 36.0%; P1, 30.4%; P2, 28.5%; M, 25.8% [
P
< .001]). The percentage of patients screened for diabetes by hemoglobin A1C increased during the initiative (BL, 17.5%; P1, 52.5%; P2, 66.8%; M 74.5% [
P
< .001]).
Conclusions
Our successful initiative can be replicated in other hospitals to standardize and improve glycemic control among diabetic surgical patients.