Percentage of adult patients undergoing an open cardiac procedure for whom any intraoperative blood glucose value did not exceed 180 mg/dL.

The chosen threshold of >180mg/dL is consistent with the Society of Thoracic Surgeons (STS) Practice Guidelines which recommends maintaining serum glucose levels ≤ 180 mg/dL for at least 24 hours after cardiac surgery.¹ This is also consistent with the 2020 Updates from the Adult Cardiac Anesthesiology Section of STS,² guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery,^3,4 as well as other supporting literature emphasizing the impact of glucose managements on outcomes in cardiac surgery.^5-11

Anesthesia Start to 30 minutes after Anesthesia End 

Adult patients undergoing open cardiac surgical procedures (determined by Procedure Type: Cardiac value code: 1).

• Age < 18 years
• ASA 6 (Organ Procurement - CPT: 01990)
• Non-cardiac, Transcatheter/Endovascular, EP/Cath, and Other Cardiac cases (determined by Procedure Type: Cardiac value codes: 0, 2, 3, and 4)

• The highest blood glucose was maintained at </=180 mg/dL, or
• Glucose >180mg/dL that was rechecked within 30-minutes and found to be ≤180mg/dL. 

• Evaluate each high glucose between anesthesia start and end. If *none* of the conditions are true for a given high glucose, the case is marked as passed.
  • Blood glucose >180mg/dL is rechecked within 30 minutes and found to be >180mg/dL = flagged.
  • Blood glucose >180 mg/dL is not rechecked within 30 minutes = flagged.
  • Any case with a glucose >180mg/dL that was rechecked within 30 minutes and found to be </=180mg/dL = pass.
  • If no high glucose values > 180 mg/dL are documented between anesthesia start and end, case is passed.
• If two blood glucose levels are documented in the same minute, the lower blood glucose will be considered for this measure (in the case of spurious values that were rechecked)
• If no blood glucose values are documented for a case, then the case will be flagged, as blood glucose values should be checked multiple times throughout the case to ensure adequate blood glucose control.
• All values mapped to glucose MPOG concepts with SI units (mmol/L) will be converted to mg/dL (mmol/L * 18.018 = mg/dL)

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Not applicable

Provider(s) signed in at the first blood glucose of >180mg/dL that was not rechecked and found to be </=180 will be attributed. In the event that two or more providers in the same role are signed in, both will be attributed. 

1. Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR, Bridges CR, Haan CK, Svedjeholm R, Taegtmeyer H, Shemin RJ, Society of Thoracic Surgeons Blood Glucose Guideline Task Force: The Society of Thoracic Surgeons practice guideline series: Blood glucose management during adult cardiac surgery. Ann Thorac Surg 2009; 87:663–9

2. Del Rio JM, Abernathy JJ 3rd, Taylor MA, Habib RH, Fernandez FG, Bollen BA, Lauer RE, Nussmeier NA, Glance LG, Petty JV 3rd, Mackensen GB, Vener DF, Kertai MD: The Adult Cardiac Anesthesiology Section of STS Adult Cardiac Surgery Database: 2020 Update on Quality and Outcomes. Anesth Analg 2020 doi:10.1213/ANE.0000000000005093

3. Engelman DT, Ben Ali W, Williams JB, Perrault LP, Reddy VS, Arora RC, Roselli EE, Khoynezhad A, Gerdisch M, Levy JH, Lobdell K, Fletcher N, Kirsch M, Nelson G, Engelman RM, Gregory AJ, Boyle EM: Guidelines for Perioperative Care in Cardiac Surgery: Enhanced Recovery After Surgery Society Recommendations. JAMA Surg 2019 doi:10.1001/jamasurg.2019.1153

4. Gregory AJ, Grant MC, Manning MW, Cheung AT, Ender J, Sander M, Zarbock A, Stoppe C, Meineri M, Grocott HP, Ghadimi K, Gutsche JT, Patel PA, Denault A, Shaw A, Fletcher N, Levy JH: Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step-But There Is Much Work to Be Done. J Cardiothorac Vasc Anesth 2020; 34:39–47

5. Gumus F, Polat A, Sinikoglu SN, Yektas A, Erkalp K, Alagol A: Use of a lower cut-off value for HbA1c to predict postoperative renal complication risk in patients undergoing coronary artery bypass grafting. J Cardiothorac Vasc Anesth 2013; 27:1167–73

6. Bansal B, Carvalho P, Mehta Y, Yadav J, Sharma P, Mithal A, Trehan N: Prognostic significance of glycemic variability after cardiac surgery. J Diabetes Complications 2016; 30:613–7

7. Hruska LA, Smith JM, Hendy MP, Fritz VL, McAdams S. Continuous insulin infusion reduces infectious complications in diabetics following coronary surgery. Journal of cardiac surgery. 2005;20(5):403-407

8. Bhamidipati CM, LaPar DJ, Stukenborg GJ, Morrison CC, Kern JA, Kron IL, Ailawadi G: Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2011; 141:543–51

9. Song JW, Shim JK, Yoo KJ, Oh SY, Kwak YL: Impact of intraoperative hyperglycaemia on renal dysfunction after off-pump coronary artery bypass. Interact Cardiovasc Thorac Surg 2013; 17:473–8 

10. KDIGO. 2012. “KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.” https://kdigo.org/wp-content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf

11. NICE-SUGAR Study Investigators, Finfer S, Chittock DR, Su SY-S, Blair D, Foster D, Dhingra V, Bellomo R, Cook D, Dodek P, Henderson WR, Hébert PC, Heritier S, Heyland DK, McArthur C, McDonald E, Mitchell I, Myburgh JA, Norton R, Potter J, Robinson BG, Ronco JJ: Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360:1283–97