Background: Maintaining perioperative glycemic control is important for patients undergoing a surgical procedure to prevent postoperative complications.
Methods: The authors conducted a pilot project designed to detect and manage perioperative hyperglycemia in a women’s hospital in Virginia. Point of Care (POC) fasting blood glucose tests were performed on the day of surgery in high risk patients. Criteria for screening were: known diabetes, BMI >30 and age > 45. Patients with hyperglycemia were treated according to a protocol using a bolus of intravenous insulin and/or insulin infusion.
Results: Of the 1478 patients undergoing surgery, 1187 (80%) met criteria for POC glucose testing during the 12 week pilot. Forty-eight percent had fasting blood glucose values of either impaired glucose/prediabetes (100 mg/dL-125mg/dl) or higher (see figure) . Seven patients had a fasting glucose of > 200 mg/dl and met criteria to receive insulin in the O.R. Six of these seven patients had known diabetes. A single patient with previously undiagnosed diabetes qualified for insulin therapy. In no circumstance was surgery delayed or cancelled due to hyperglycemia.
Conclusion: Screening for hyperglycemia in the preoperative area is a valuable tool for identifying patients who may benefit from intraoperative insulin therapy. The vast majority of patients who require rescue insulin therapy in the operating room have known diabetes.
S.Ahmad: None. K.K.Edmiston: None. B.Good: None. M.W.Jeffery: Other Relationship; Medtronic. P.W.Clougherty: None. S.Clement: Research Support; Novo Nordisk.
Division of Endocrinology, Medicine Service Line, Inova Health System
