A diabetes optimization pathway for elective surgical patients with uncontrolled diabetes (A1c> 8%) has been in place at our institution for the last 5 years. Although we reported on improvement in glucose control before surgery in patients undergoing the intervention, impact on longer-term clinical outcomes was not known. We extracted EPIC medical record data for adult surgical patients in the diabetes optimization program between January 2016 and October 2021 (n=85) . The control group had uncontrolled diabetes and underwent surgery but had no intervention (n=1,111) . Logistic regression, GLM and Cox proportional hazard models were used to investigate relationship with 30 day complications, glucose at surgery, and overall mortality. Table 1 shows bivariate comparisons for the study cohort. The rates of perioperative complications were numerically lower in the intervention group, however, were not statistically significant. Unadjusted regression analyses found significantly lower glucose at surgery (β =-14.19, 95% CI=-27.94,-0.43) , and significantly lower hazard ratio for overall mortality (HR=0.34, 95% CI=0.13,0.93) for the intervention. After adjusting for demographics, clinical risk, and comorbidities, only glucose at surgery maintained significance (β =-16.89, 95% CI=-30.83,-2.95) . Prospective studies or a larger sample may be needed to confirm findings.
C.E.Mendez: Advisory Panel; Monarch Medical Technologies . R.J.Walker: None. E.Garacci: None. K.Pfeifer: None.