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Alerts ease surgery for patients with diabetes

Nov. 8, 2012, 10:39 AM

A monitoring and alert system developed and implemented at Vanderbilt University Medical Center that prompts caregivers to check glucose levels for patients with diabetes while they are undergoing surgery has been found to help improve outcomes such as reduced abnormal glucose values, fewer surgical site infections and reduced hospital readmissions after surgery.

Approximately 17.5 million people in the United States have diabetes. These patients are known to have a higher likelihood of undergoing major surgery, a higher risk of adverse events during surgery and a 30 percent to 50 percent longer stay in the hospital post-surgery.

Jesse Ehrenfeld, M.D., MPH, and colleagues are working to improve surgical outcomes for patients with diabetes. (photo by Susan Urmy)

“Avoiding extremes in blood glucose values, especially hypoglycemia or low blood sugar, is imperative to ensuring the safety of patients with diabetes during surgery,” said study author Jesse Ehrenfeld, M.D., MPH, assistant professor of Anesthesiology and Biomedical Informatics.

“This is particularly important for surgical patients because the clinical signs of hypoglycemia can be masked by general anesthesia while patients are unable to communicate with their physicians.”

To better maintain glycemic control throughout the perioperative period (defined as before, during and immediately after surgery), the VUMC Perioperative Informatics Group developed an automated system to routinely remind caregivers to monitor a patient’s blood glucose level.

To learn the efficacy of the improved monitoring, Ehrenfeld studied the effects of electronic notifications regarding intraoperative glucose testing being provided to anesthesia providers during surgery, and his results were featured this month during the American Society of Anesthesiologists’ Annual Meeting in Washington, D.C.

“There are some really exciting results,” Ehrenfeld said. “We found that the point-of-care notifications reduced the number of dangerously out-of-range blood sugar values.  We also found that fewer patients had surgical site infections after surgery, and that patients who were enrolled in this study got readmitted to the hospital less often after they went home.”

The study, which was conducted at both VUMC and Massachusetts General Hospital, included 13,384 patients undergoing routine surgeries from May 2010 to July 2012.

The Intraoperative Glucose Monitoring Alert recommended that glucose be measured every hour if insulin was administered during surgery, and every two hours if a patient with diabetes was undergoing surgery but not receiving intraoperative insulin.

The following results were measured: the impact of point-of-care notifications on glucose monitoring, dangerously out-of-range blood sugar values, surgical site infection rates and hospital length of stay.

“The results of this study are likely to change care for the thousands of patients with diabetes who undergo surgical procedures every day,” said Ehrenfeld.

“While this study was conducted at two large academic medical centers, we have enough confidence in these results and there was enough improvement in patient care and outcomes that we believe that an adoption of a similar strategy across the nation and across the world will impact millions of patients every year.”

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