title: Perioperative glycemic control: use of a hospital-wide protocol to safely improve hyperglycemia.
abstract: Perioperative hyperglycemia impairs immunity and contributes to increased susceptibility to infection, higher incidence of multiorgan dysfunction, and greater mortality. Strict glycemic control is associated with lower infection rates, decreased length of stay (LOS), and faster recovery. A protocol that standardized preoperative education, testing, and treatment of elevated blood glucose (BG) safely improved perioperative glycemic control. Preoperative average BG improved from 191 to 155 mg/dL (P=.016); postoperative average BG decreased from 189 to 168 mg/dL (P=.094). The percentage of patients presenting with BG greater than 180 mg/dL preoperatively and achieving BG less than 180 mg/DL postoperatively increased from 21% to 43% (P = .09). Even though some results were statistically non-significant, the data showed a trend toward improvement with the new protocol. Good perioperative glycemic control, without an increased risk of hypoglycemia, is achievable.
authors.affiliation: PinnacleHealth System, Harrisburg, PA 17105-8700, USA. nmichaelian@pinnaclehealth.org
authors.forename: Nancy
authors.initials: N
authors.lastname: Michaelian
authors.forename: Renu
authors.initials: R
authors.lastname: Joshi
authors.forename: Ed
authors.initials: E
authors.lastname: Gillman
authors.forename: Ronald
authors.initials: R
authors.lastname: Kratz
authors.forename: Amy
authors.initials: A
authors.lastname: Helmuth
authors.forename: Karen
authors.initials: K
authors.lastname: Zimmerman
authors.forename: Denise
authors.initials: D
authors.lastname: Klahre
authors.forename: Sandy
authors.initials: S
authors.lastname: Warner
authors.forename: Vickie
authors.initials: V
authors.lastname: McBride
authors.forename: M Judy
authors.initials: MJ
authors.lastname: Bailey
authors.forename: Linda
authors.initials: L
authors.lastname: Houseal
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D059035:Perioperative Period
chemical_list: D001786:Blood Glucose