Abstract
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.
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Acknowledgment
The authors thank Laura L. Russell, scientific editor, Research Medical Library, for editing this article. This research was in part supported by the National Institutes of Health through M.D. Anderson's Cancer Center Support Grant CA016672.
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Prior presentations: A summary or an earlier analysis of this work has been presented at the American College of Surgery Quality Forum in 2021 and at the Institute for Healthcare Improvement Conference in 2021.
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Taylor, J.S., Fellman, B.M., Raty, S. et al. Detection and Management of Perioperative Hyperglycemia at a Tertiary Cancer Center. Ann Surg Oncol 31, 3017–3023 (2024). https://doi.org/10.1245/s10434-024-14986-7
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DOI: https://doi.org/10.1245/s10434-024-14986-7