TY - JOUR
T1 - Detection and Management of Perioperative Hyperglycemia at a Tertiary Cancer Center
AU - Taylor, Jolyn S.
AU - Fellman, Bryan M.
AU - Raty, Sally
AU - Lasala, Javier
AU - Iniesta, Maria D.
AU - Cain, Katherine E.
AU - Horner, Allison A.
AU - Bruno, Morgan
AU - Folloder, Justin P.
AU - Knippel, Susan L.
AU - Khanh, Vu
AU - Popovich, Shannon
AU - Katz, Matthew H.G.
AU - Best, Conor
AU - Thosani, Sonali
N1 - Publisher Copyright:
© Society of Surgical Oncology 2024.
PY - 2024
Y1 - 2024
N2 - 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.
AB - 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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U2 - 10.1245/s10434-024-14986-7
DO - 10.1245/s10434-024-14986-7
M3 - Article
C2 - 38347330
AN - SCOPUS:85185127648
SN - 1068-9265
VL - 31
SP - 3017
EP - 3023
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 5
ER -