دورية أكاديمية
Detection and Management of Perioperative Hyperglycemia at a Tertiary Cancer Center.
العنوان: | Detection and Management of Perioperative Hyperglycemia at a Tertiary Cancer Center. |
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المؤلفون: | Taylor JS; Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, USA. Jstaylor1@mdanderson.org., Fellman BM; Department of Biostatistics, M. D. Anderson Cancer Center, Houston, USA., Raty S; Department of Anesthesiology, M. D. Anderson Cancer Center, Houston, USA., Lasala J; Department of Anesthesiology, M. D. Anderson Cancer Center, Houston, USA., Iniesta MD; Department of Gynecologic Oncology and Reproductive Medicine, M. D. Anderson Cancer Center, Houston, USA., Cain KE; Department of Pharmacy Clinical Programs, M. D. Anderson Cancer Center, Houston, USA., Horner AA; Department of Breast Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA., Bruno M; Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA., Folloder JP; Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA., Knippel SL; Department of Thoracic and Cardiovascular Surgery, M. D. Anderson Cancer Center, Houston, USA., Khanh V; Department of Internal Medicine, M. D. Anderson Cancer Center, Houston, USA., Popovich S; Department of Perioperative Medicine, M. D. Anderson Cancer Center, Houston, USA., Katz MHG; Department of Surgical Oncology, M. D. Anderson Cancer Center, Houston, USA., Best C; Department of Endocrinology, M. D. Anderson Cancer Center, Houston, USA., Thosani S; Department of Endocrinology, M. D. Anderson Cancer Center, Houston, USA. |
المصدر: | Annals of surgical oncology [Ann Surg Oncol] 2024 May; Vol. 31 (5), pp. 3017-3023. Date of Electronic Publication: 2024 Feb 12. |
نوع المنشور: | Journal Article |
اللغة: | English |
بيانات الدورية: | Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE |
أسماء مطبوعة: | Publication: 2005- : New York, NY : Springer Original Publication: New York, NY : Raven Press, c1994- |
مواضيع طبية MeSH: | Hyperglycemia*/diagnosis , Hyperglycemia*/etiology , Diabetes Mellitus*/diagnosis , Neoplasms*, Humans ; Blood Glucose ; Glycated Hemoglobin ; Perioperative Care ; Retrospective Studies |
مستخلص: | 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. (© 2024. Society of Surgical Oncology.) |
References: | Omar AS, et al. Association of time in blood glucose range with outcomes following cardiac surgery. BMC Anesthesiol. 2015;15(1):1–8. (PMID: 10.1186/1471-2253-15-14) Ouattara A, et al. Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. J Am Soc Anesthesiol. 2005;103(4):687–94. (PMID: 10.1097/00000542-200510000-00006) Shohat N, et al. Increased postoperative glucose variability is associated with adverse outcomes following orthopaedic surgery. Bone Joint J. 2018;100(8):1125–32. (PMID: 10.1302/0301-620X.100B8.BJJ-2017-1283.R130062937) Kiran RP, et al. The clinical significance of an elevated postoperative glucose value in nondiabetic patients after colorectal surgery: evidence for the need for tight glucose control? Ann Surg. 2013;258(4):599–605. (PMID: 10.1097/SLA.0b013e3182a501e323979274) Van den Berghe G, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359–67. (PMID: 10.1056/NEJMoa01130011794168) Investigators TN-SS. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283–97. (PMID: 10.1056/NEJMoa0810625) United Stated Preventative Services Task Force. Abnormal blood glucose and type 2 diabetes mellitus: Screening. October 2015. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-abnormal-blood-glucose-and-type-2-diabetes-october-2015 . Accessed 24 Aug 2022. Al-Niaimi AN, et al. Intensive postoperative glucose control reduces the surgical site infection rates in gynecologic oncology patients. Gynecol Oncol. 2015;136(1):71–6. (PMID: 10.1016/j.ygyno.2014.09.01325263249) |
معلومات مُعتمدة: | National Institutes of Health through M.D. Anderso NIH Clinical Center |
المشرفين على المادة: | 0 (Blood Glucose) 0 (Glycated Hemoglobin) |
تواريخ الأحداث: | Date Created: 20240212 Date Completed: 20240410 Latest Revision: 20240410 |
رمز التحديث: | 20240410 |
DOI: | 10.1245/s10434-024-14986-7 |
PMID: | 38347330 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1534-4681 |
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DOI: | 10.1245/s10434-024-14986-7 |