Profiling Factors and Outcomes of Hyperglycemia After Cardiac Surgeries: An Important Step to Improve a Quality Measure
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PublisherThe University of Arizona.
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AbstractBackground: Elevated blood glucose in patients undergoing cardiac surgery pose increased risks of sternal incision infections, kidney disease, irregular heartbeats, extended hospital stays, and death. Elevated blood glucose also increases the costs of healthcare from prolonged lengths of stay and increased complications. The Surgical Care Improvement Project (SCIP) #4 performance measure is used to evaluate achievement of a target blood glucose control < 200 milligram/deciliter (mg/dl) post cardiac surgery on postoperative days 1 and 2. In the institution where this study was carried out, blood sugar control in the cardiac surgery patient has presented a challenge. Purpose: The purpose of this practice inquiry was to identify patient characteristics and outcomes in cardiac surgery patients who met the SCIP #4 performance measure versus those patients who did not. Methods: A retrospective nested case-control design was used. Risk factors for postoperative hyperglycemia and in-hospital outcomes were compared between cardiac surgery patients who were SCIP #4 met defined as 6AM BG ≤ 200 mg/dl on postoperative days 1 and 2 and those that were SCIP #4 not met, defined as 6AM BG > 200 mg/dl on postoperative days 1 or 2. Results: Results from this study showed that preoperative hemoglobin AIC and history of diabetes were two major contributors for SCIP #4 not-met status. There was a trend towards a longer length of stay in the SCIP #4 not met group as compared to the met group (9.01 ± 7.33 versus 7.30 ± 4.93 days, respectively; p = . 096). Mortality was 3 times more prevalent in the SCIP #4 not met than the met group (6.2% versus 2.1%, respectively); however, this different did not reach statistical significance (p = .129). Renal failure was four-fold more frequent in patients who were SCIP #4 not-met than who were SCIP #4 met (13.6% vs. 4.1%, respectively; p = 0.003). Conclusions: Results from this study showed that SCIP #4 not met is associated with development of postoperative renal failure in the hospital and a trend towards longer length of stay. History of diabetes and preoperative hemoglobin AIC level should be taken into consideration when evaluating strategies for managing hyperglycemia. Future research is needed to study the relationship between SCIP #4 met status and long-term outcomes. The use of preoperative hemoglobin A1C to identify patients at high risk for uncontrolled postoperative glucose and plan effective glucose control should be studied. Such study may include implementing intravenous insulin on all patients with diabetes and elevated hemoglobin A1C levels and comparing the short and long term outcomes.
Degree ProgramGraduate College