Steady sugar in surgery

Adding increased glucose monitoring throughout surgical procedures will allow anaesthetists to optimise the perioperative and surgical care of millions of diabetic patients throughout the world, according to a new study.

Approximately 2.5 million people in England have diabetes and an estimated further 850,000 people are, unbeknownst to them, living with the condition. These patients are known to have a higher likelihood of undergoing major surgeries than non-diabetic patients, they have a higher risk of adverse events during surgery, and a 30 to 50 percent longer stay in the hospital post-surgery.

The optimal strategy to manage blood sugar in diabetic patients undergoing surgery is still up for debate, and the study, presented at the ANESTHESIOLOGY 2012 annual meeting, establishes that increased vigilance through perioperative monitoring provides clinicians an important method for greatly improving care for this significant patient population.

“Avoiding extremes in blood glucose values, especially hypoglycemia or low blood sugar, is imperative to ensuring the safety of diabetic patients during surgery,” said study author Jesse M. Ehrenfeld, M.D., M.P.H., Department of Anesthesiology and Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tenn. “This is particularly important for surgical patients because the clinical signs of hypoglycemia can be masked by general anaesthesia while patients are unable to communicate with their physicians.”

A prospective multicenter trial was launched, in which electronic notifications were provided to anaesthesia providers during surgery to guide their performance of intraoperative glucose testing. A total of 13,384 patients were enrolled 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 120 minutes if a diabetic patient was undergoing surgery, but not receiving intraoperative insulin. The following results were measured: the impact of these point-of-care notifications on glucose monitoring, dangerously out-of-range blood sugar values, surgical site infection rates and hospital length of stay.

To date, the results indicate the rate of glucose testing during surgery was greatly improved, and fewer patients had a dangerously abnormal glucose value. Statistically significant reductions in surgical site infections and 14-day readmissions were also observed in the intervention group.

Already, the implementation of intraoperative glucose monitoring notifications have led to an important improvement in surgical care, reduced markedly abnormal glucose values, fewer surgical site infections and reduced hospital readmissions post-surgery.

“The results of this study are likely to change the standard of care for the thousands of diabetic patients who undergo surgical procedures and anaesthesia every day,” said Dr Ehrenfeld.

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