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Patients with and without diabetes who have postoperative hyperglycemia have worse outcomes than patients with in-target blood sugars. Previous quality improvement work suggests numerous barriers and clinical inertia may contribute to quality gaps in glycemic management for surgical patients. Using a framework for perioperative glycemic management, we sought to measure quality gaps in perioperative glycemic care.
This cross-sectional study used administrative data to measure the proportion of surgical patients with and without known diabetes who underwent preoperative hemoglobin A1c measurement, postoperative point-of-care testing for glucose (POCT), had hyperglycemia, and received basal bolus insulin regimens for treatment. We performed an exploratory analysis comparing length of stay (LOS) in patients with and without diabetes who had and did not have postoperative hyperglycemia.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Diabetes with postoperative hyperglycemia | Patients with known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who had postoperative hyperglycemia (point of care test > 10.0 mmol/L). |
| |
| Diabetes without postoperative hyperglycemia | Patients with known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who did not have postoperative hyperglycemia (point of care test > 10.0 mmol/L). | ||
| No diabetes with postoperative hyperglycemia | Patients without known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who had postoperative hyperglycemia (point of care test > 10.0 mmol/L). |
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| No diabetes and no postoperative hyperglycemia | Patients without known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who did not have postoperative hyperglycemia (point of care test > 10.0 mmol/L). |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Exposure - postoperative hyperglycemia | Other | Postoperative hyperglycemia (blood or capillary glucose > 10.0 mmol/L) within 72 hours of a surgical procedure |
|
| Measure | Description | Time Frame |
|---|---|---|
| Number of point of care blood glucose measurements in 24-hours after surgery | 24-hours post surgery | |
| Proportion of patients who have hyperglycemia | blood or capillary glucose > 10 mmol/L | 24-hours after surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Proportion of patients who have moderate hyperglycemia | blood or capillary glucose 14.0-17.9 mmol/L | 24-hours after surgery |
| Proportion of patients who have severe hyperglycemia | blood or capillary glucose > 18.0 mmol/L |
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Inclusion Criteria:
Exclusion Criteria:
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All patients undergoing a surgical procedure at the Foothills Medical Centre who were admitted for at least 24-hours.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Foothills Medical Centre | Calgary | Alberta | T2N 4T9 | Canada |
Data is available from the study principal investigator upon reasonable request.
Present for five years after study completion (March 31 2020).
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| ID | Term |
|---|---|
| D003920 | Diabetes Mellitus |
| D006943 | Hyperglycemia |
| ID | Term |
|---|---|
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
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| 24-hours after surgery |
| Hospital Length of stay | Hospital length of stay (days) | Until study completion (up to one year from surgical procedure) |