This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.
Percentage of cases with perioperative glucose > 200 mg/dL with administration of insulin or glucose recheck within 90 minutes of original glucose measurement.
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.
10229 Insulin Aspart
10230 Insulin Glargine
10231 Insulin Novolin
10232 Insulin NPH
10233 Insulin Regular
10659 Insulin- Unspecified
3361 POC- Glucose (Fingerstick)
3362 POC- Glucose (Unspecified Source)
3405 POC- Blood Gas - Glucose
5003 Formal Lab-Glucose, Serum/Plasma
5036 Formal Lab-Blood Gas, Glucose
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.