Relevance of the Surgical Care Improvement Project on glycemic control in patients undergoing cardiac surgery who receive continuous insulin infusions.
OBJECTIVE
The Surgical Care Improvement Project (SCIP) has benchmarked 6:00 am blood glucose levels of less than 200 mg/dL on postoperative day (POD) 1 and 2 as quality measures of glycemic control in cardiac surgery. This study was undertaken to (1) determine the incidence of SCIP outliers in patients receiving a continuous insulin infusion (CII) targeted to maintain perioperative serum glucose levels less than 180 mg/dL after cardiac surgery, (2) identify the profile of patients who are SCIP outliers, (3) determine whether SCIP outliers have increased morbidity and mortality, and (4) identify more relevant benchmarks for glycemic control in patients having cardiac surgery.


METHODS
Between January 1, 2008, and April 30, 2011, a total of 832 patients underwent cardiac surgery and received CII to maintain serum blood glucose levels of less than 180 mg/dL. Patients were divided into 2 groups: patients compliant with SCIP and SCIP outliers.


RESULTS
The incidence of SCIP outliers was 6.6% (55/832). Patients more likely to be SCIP outliers had diabetes mellitus (38, 69% vs 250, 32%; P < .0001), a higher hemoglobin A1c (8.74 ± 2.25 vs 7.59 ± 2.90; P < .0009), and a higher body mass index (31.1 ± 6.5 vs 29.2 ± 5.7; P = .03). However, SCIP outliers had no increase in morbidity, mortality, or hospital length of stay.


CONCLUSIONS
Patients undergoing cardiac surgery may still be SCIP outliers despite CII targeted to maintain serum glucose levels below 180 mg/dL; however, SCIP outliers had no increase in morbidity, mortality, or length of stay.
Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Boston, MA, USA.
Marie E
ME
McDonnell
Sara M
SM
Alexanian
Ana
A
Junqueira
Howard
H
Cabral
Harold L
HL
Lazar
D000368:Aged; D019985:Benchmarking; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects*; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007263:Infusions, Parenteral; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D058996:Quality Improvement / Q000592:standards; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human