Percentage of adult patients undergoing open cardiac surgical procedures for whom any blood glucose measure >/=180mg/dL was either treated with insulin or rechecked and found to be <180mg/dL within 30 minutes.

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)

For any blood glucose ≥180mg/dL, at least one of the following interventions are documented:

• Treatment with insulin within 30 minutes, or
• Glucose rechecked and found to be below 180mg/dL within 30 minutes

• Each blood glucose is evaluated separately.  
• The measure evaluates the following conditions for each high glucose, prioritized in this order. If *none* of the conditions are true for a given high glucose, the case is marked as flagged
  • An insulin administration was given within 30 minutes of the high glucose = value passes
  • An insulin infusion is active when the high glucose was resulted = value passes (Note: If no end time is available for an insulin infusion, the ‘measure end time’ will be considered the insulin infusion end time.)
  • Another glucose value < 180 was resulted within 30 minutes of the high glucose = value passes

• If any of the values for a case are considered flagged, the case is flagged. If all values are excluded for a case, the case is excluded from the measure. 
• 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)
• 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 glucose recheck or first administration of insulin following a blood glucose of >/=180mg/dL. If neither occurred, then the responsible provider is the one signed in 30 minutes after the high glucose measurement. 

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