Percentage of patients with a blood glucose >200 mg/dL with documentation of insulin treatment (SQ or IV).
Surgical and anesthetic stress increases hyperglycemia incidence in both diabetics and non-diabetics.3,22 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 The Society for Ambulatory Anesthesia, American Association of Clinical Endocrinologists, The Society for Thoracic Surgery, and the Joint British Diabetes Society also recommend blood glucose management <180 mg/dL.14, 15,16, 17, 18 The ADA 2019 guidelines call for perioperative blood glucose ranges from 80-180mg/dL..19 Patients undergoing anesthesia are at risk of hypoglycemia as the effects of anesthesia can mask the symptoms of hypoglycemia; however, conventional glucose targets of <180 mg/dL have not been associated with significant risk of hypoglycemia.1,20,21 Frequent blood glucose monitoring after insulin administration is recommended. Intraoperative glucose levels should be checked every 2 hours or more frequent and insulin infusions should be monitored at least hourly.3 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
*Cases where the ‘Measure End Time’ precedes ‘Measure Start Time’ will be excluded and marked 'invalid'
Administration of insulin within 90 minutes of blood glucose >200 mg/dL
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
|Brooke Szymanski-Bogart, RN||University of Michigan|
|Genevieve Bell||University of Michigan|
|Nirav Shah, MD||University of Michigan|
|MPOG Quality Committee|
|Date Reviewed||Reviewer||Institution||Summary||QC Vote|
Patrick Henson, MD
Update the threshold for GLU-01, GLU-03, and GLU-05 to 180mg/dL,
and develop new recheck measures.
|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|