title: Surgical Care Improvement Project measure for postoperative glucose control should not be used as a measure of quality after cardiac surgery.
abstract: OBJECTIVE
  The current Surgical Care Improvement Project (SCIP) measure for controlled postoperative 6-am glycemic control after cardiac surgery identifies those with blood glucose levels of ≤200 mg/dL. The purpose of the present study was to evaluate the effect of achieving this SCIP measure on risk-adjusted postoperative cardiac surgical outcomes.
  
  
  METHODS
  The data were analyzed for all cardiac surgery patients from a single institution (June 2010 to August 2012). The patients were categorized by the postoperative 6-am glucose levels into 2 SCIP measure cohorts: SCIP (≤200 mg/dL) versus non-SCIP (>200 mg/dL). Propensity-matched cohort comparisons and multiple regression analyses assessed the associations between SCIP measure compliance and the risk-adjusted outcomes.
  
  
  RESULTS
  Of 1703 patients, 1527 (90%) achieved SCIP measure glycemic control. Preoperative diabetes was more common among the non-SCIP patients (P < .001); the median Society of Thoracic Surgeons-predicted mortality (P = .14) was similar between the 2 groups. No significant differences were observed in major morbidity, mortality, or resource usage among the propensity-matched cohorts. After adjustment for Society of Thoracic Surgeons-predicted risk, non-SCIP status was not associated with increased mortality (P = .44), composite major morbidity (P = .16), major sternal complications (P = .68), total intensive care unit duration (P = .70), or postoperative length of stay (P = .27). Similar risk-adjusted results were estimated for patients undergoing isolated coronary artery bypass grafting.
  
  
  CONCLUSIONS
  Achieving the SCIP measure for controlled postoperative 6-am blood glucose levels ≤200 mg/dL after cardiac surgery was not associated with improved risk-adjusted mortality, morbidity, or hospital resource usage. These data suggest that this metric might not be a valid measure of postoperative cardiac surgical quality.
authors.affiliation: Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va.
authors.forename: Damien J
authors.initials: DJ
authors.lastname: LaPar
authors.affiliation: Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va.
authors.forename: James M
authors.initials: JM
authors.lastname: Isbell
authors.affiliation: Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va.
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.affiliation: Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va.
authors.forename: Gorav
authors.initials: G
authors.lastname: Ailawadi
authors.affiliation: Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va. Electronic address: ilk@virginia.edu.
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000592:standards; D016009:Chi-Square Distribution; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D057216:Propensity Score; D058996:Quality Improvement / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014768:Virginia
chemical_list: D015415:Biomarkers; D001786:Blood Glucose