Percentage of cases with perioperative glucose < 60 with administration of dextrose containing solution or glucose recheck within 90 minutes of original glucose measurement

Intraoperative

• All patients with glucose level less than 60 mg/dL between Anesthesia Start and Anesthesia End
• Patients with and without diagnosis of diabetes

• ASA 5 and 6 cases
• Glucose measurements < 60 mg/dL within 90 minutes before Anesthesia End  
• Obstetric Non-Operative Procedures- CPT 01958, 01960, 01967
• Obstetric Non-Operative Procedures with procedure text: “Labor Epidural”

• Administration of dextrose containing solution within 90 minutes (IV)  OR
• Recheck of glucose level within 90 minutes

• Percentage of intraoperative glucose labs with perioperative glucose <60 with administration of dextrose containing solution or glucose recheck within 90 minutes of original glucose measurement for the time period between Anesthesia Start and Anesthesia End.

The provider signed in at the first glucose recheck or first administration of dextrose. If neither occurred, then the responsible provider is the one signed in 90 minutes after the low glucose measurement.

• Percentage of Cases with Insulin Administration Mapped Correctly
• Percentage of Cases with POC Glucose Labs
• Percentage of Cases with a Lab Drawn during Anesthesia
• Percentage of Labs Mapped to a Meaningful Lab Mapping
• Percentage of Medications with a Meaningful Medication Mapping
• Percentage of Fluids with a Meaningful Fluid Mapping

The American Diabetes Association uses an outpatient hypoglycemia definition of <70 mg/dL^6,7. Severe hypoglycemia in inpatients is considered <40mg/dL⁶. Acute hypoglycemia in the perioperative period can lead to inadequate supply of glucose to the brain, resulting in seizures, permanent brain damage, and death.  In hospitalized diabetic patients, hypoglycemia has been associated with increased length of stay and mortality.⁵ The risk of negative sequelae related to hypoglycemia is reduced with early recognition and treatment of mild to moderate hypoglycemia (40-69mg/dL)^6,8,9. The common signs/symptoms of hypoglycemia are masked by general anesthesia, making vigilance and quick treatment especially important.¹ Fasting patients with or without diabetes and diabetic patients treated with oral glycemic agents or insulin are at increased risk of perioperative hypoglycemia.^2-3

Perioperative hypoglycemia is a rare event typically caused by the following: ⁴

1. Insulin overdose, either by patient taking higher than normal doses on the morning of surgery or by providers giving more insulin than necessary
2. Septic or circulatory shock
3. Failure to monitor

Not applicable

1. 1. Akhtar, Shamsuddin, Paul G. Barash, and Silvio E. Inzucchi. 2010. “Scientific Principles and Clinical Implications of Perioperative Glucose Regulation and Control.” Anesthesia and Analgesia 110 (2): 478–97.
       
   2. Falconer, R., C. Skouras, T. Carter, L. Greenway, and A. M. Paisley. 2014. “Preoperative Fasting: Current Practice and Areas for Improvement.” Updates in Surgery 66 (1): 31–39.
       
   3. Leung, Vivien, and Kristal Ragbir-Toolsie. 2017. “Perioperative Management of Patients with Diabetes.” Health Services Insights 10 (November): 1178632917735075.
       
   4. Schwenk, Eric S., Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, and Richard H. Epstein. 2012. “Root Causes of Intraoperative Hypoglycemia: A Case Series.” Journal of Clinical Anesthesia 24 (8): 625–30.
       
   5. Turchin, Alexander, Michael E. Matheny, Maria Shubina, James V. Scanlon, Bonnie Greenwood, and Merri L. Pendergrass. 2009. “Hypoglycemia and Clinical Outcomes in Patients with Diabetes Hospitalized in the General Ward.” Diabetes Care 32 (7): 1153–57.
   6. Moghissi, Etie S., Mary T. Korytkowski, Monica DiNardo, Daniel Einhorn, Richard Hellman, Irl B. Hirsch, Silvio E. Inzucchi, et al. 2009. “American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control.” Diabetes Care 32 (6): 1119–31.
   7. Cryer, Philip E., Stephen N. Davis, and Harry Shamoon. 2003. “Hypoglycemia in Diabetes.” Diabetes Care 26 (6): 1902–12.
   8. DiNardo, Monica, Michelle Noschese, Mary Korytkowski, and Stephanie Freeman. 2006. “The Medical Emergency Team and Rapid Response System: Finding, Treating, and Preventing Hypoglycemia.” Joint Commission Journal on Quality and Patient Safety / Joint Commission Resources 32 (10): 591–95.
   9. DiNardo, M., A. C. Donihi, M. DeVita, L. Siminerio, H. Rao, and M. T. Korytkowski. 2005. “A Nurse Directed Protocol for Recognition and Treatment of Hypoglycemia in Hospitalized Patients.” Pract Diabetol 22: 37–40.