Percentage of cases with perioperative glucose <70mg/dL with administration of glucose or dextrose containing solution or glucose recheck within 30 minutes of original glucose measurement.

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

Preop start to PACU end

• All patients with glucose level less than 70 mg/dL
• Patients with and without diagnosis of diabetes

• ASA 5 & 6 including Organ Procurement (CPT: 01990)
• Glucose measurements < 70 mg/dL within 30 minutes before measure end 
• Labor Epidurals (determined by Obstetric Anesthesia Type value codes: 3 & 6 including obstetric non-operative procedures - CPT: 01958)

• Administration of glucose or dextrose containing solution within 30 minutes (IV) OR
• Recheck of glucose level within 30 minutes

• 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

Preop start to Anesthesia Start: The first anesthesia provider(s) signed into the case

Anesthesia Start to Anesthesia End: The provider(s) 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.

Anesthesia End to PACU End: The last anesthesia provider(s) signed into the case.

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.

Published Date: 07/2023