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IMPROVED OUTCOMES IN DIABETIC SURGICAL PATIENTS WITH PERI-OPERATIVE GLUCOSE MANAGEMENT
Vanita Ahuja1,2, Abdel Salous*1
1Surgery, Sinai Hospital, Baltimore, MD; 2Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
Background: Our community hospital operative 30-day outcome report revealed a concerning trend in morbidity for postoperative general surgery patients. Data analysis identified peri-operative hyperglycemia as the common preoperative risk factor for increased post-operative morbidity in these patients with diabetes mellitus (DM). The goal of our study was to improve blood glucose control in elective surgery patients and its association with decreased morbidity.
Methods: A multidisciplinary team with representatives from infection control, anesthesia, pharmacy, surgical residents, and nursing was assembled to determine corrective action and plan for implementation of the action. Educational seminars were conducted to promote awareness about hyperglycemia and postoperative morbidity in DM patients to anesthesia, surgeons, residents and nurses. A standardized protocol was created for management of preoperative patients with DM. The management started with optimizing glucose control at the preoperative visit by a nurse practitioner followed by optimal control on the nursing unit with oversight by a diabetic nurse specialist. An electronic medical record order set of the protocol was implemented and used for documentation.
Results: Data was captured using ACS National Surgical Quality Improvement Program (NSQIP) prospectively. Data review for July-Dec 2016 showed that there were a total of 83 patients with DM having elective general surgery with a morbidity of 9.27%. Metrics for adherence were measured by usage of the order set and monitoring postoperative morbidity outcomes in DM patients. Morbidity was defined as a patient having 1 or more of the specific NSQIP post-operative complications. Since implementation there have been 93 patients with decrease in overall morbidity to 7.8% and with overall improvement at our center in post-operative morbidity. The morbidity was below the national rate of 8.7%.
Conclusion: The goal of this (QI) project is to decrease post-operative morbidity in patients with DM by implementation of perioperative blood glucose level monitoring and treatment. Our preliminary data strongly suggests that process change with incorporating electronic tools into daily work flow may improve outcomes.
Decrease in post-operative morbidity with control of peri-operative glucose in general surgery diabetic patients
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