Percentage of cases with perioperative glucose > 200 mg/dL with administration of insulin or glucose recheck within 90 minutes of original glucose measurement.
Surgical and anesthetic stress increases hyperglycemia incidence in both diabetics and non-diabetics.3 Perioperative hyperglycemia is mediated by the release of proinflammatory cytokines (e.g., TNF-alpha and IL-6) and elevated concentrations of catecholamines, growth hormone, glucagon, and glucocorticoids.4 These mediators induce metabolic alterations in carbohydrate balance that alter peripheral glucose uptake and utilization, increase gluconeogenesis, depress glycogenesis, and induce glucose intolerance and insulin resistance. Hyperglycemia can also be drug induced (administration of steroids).
Acute hyperglycemia in the perioperative period is known to increase the incidence of wound infections, overall mortality, length of stay, acute kidney injury, and delayed wound healing. 2,5,7, 8-12 Use of insulin to correct perioperative hyperglycemia decreases the risk of hospital complications and mortality in cardiac and general surgery patients.6, 12 The American Association of Clinical Endocrinologists and American Diabetes Association recommend a treatment threshold of 180 mg/dL in critically ill hospitalized patients and a preprandial blood glucose goal of 140 mg/dL in non-critically hospitalized ill patients.13 Patients undergoing anesthesia who are subject to tight glucose control are at greater risk of hypoglycemia as the effects of anesthesia can mask the symptoms of hypoglycemia and current methods of treatment and monitoring put patients at risk of overcorrection.1 A relatively high threshold glucose level (greater than 200 mg/dL) is used for this measure to alleviate concerns that patients undergoing general anesthetics are at risk of overtreatment and hypoglycemia.1 Blood glucose may be rechecked in one hour.
Preop through PACU (see ‘Other Measure Build Details’ for more information)
Measure start time is determined by MPOG Phenotype 'Preop Start Time'
Meaure end time is determined by MPOG Phenotype 'PACU End Time'
Preop Time Period (preop start through anesthesia start): The first provider signed into the case
Intraop Time Period: The provider signed in at the first glucose recheck or first administration of insulin. If neither occurred, then the responsible provider is the one signed in 90 minutes after the high glucose measurement.
Postop Time Period (anesthesia end through PACU End): The last providers signed into the case
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
|02/07/2023||Exclusion||Cases with measure duration ≤30 minutes excluded & cesarean delivery hysterectomies no longer excluded.|
|10/28/2022||Success||If subcutaneous insulin was administered within 120 minutes before the high glucose result, value passes.|
|03/24/2021||Exclusion||Modified to use Obstetric Anesthesia Type phenotype|