Decisional practices and patterns of intraoperative glucose management in an academic medical center.
OBJECTIVE
To understand the decisional practices of anesthesia providers in managing intraoperative glucose levels.


METHODS
This is a retrospective cohort study.


METHODS
Operating rooms in an academic medical center.


METHODS
Adult patients undergoing surgery.


METHODS
Intraoperative blood glucose management based on an institutional protocol.


METHODS
Glucose management data was extracted from electronic medical records to determine compliance to institutional glucose management protocol that prescribes hourly glucose measurements and insulin doses to maintain glucose levels between 100 to 140mg/dL. Effect of patient and surgery specific factors on compliance to glucose management protocol was explored.


RESULTS
In 1903 adult patients compliances to hourly glucose measurements was 72.5% and correct insulin adjustments was 12.4%. Insulin was under-dosed compared to the prescribed value by a mean of 0.85U/h (95% CI 0.76-0.95). Multivariate analysis showed that compliance to hourly glucose measurements decreased with increasing length of the procedure (OR=0.92 per hour, 95% CI 0.89-0.95) but increased with ASA status codes (OR=1.25 per ASA unit, 95% CI=1.06-1.49). Greater compliance to correct insulin adjustment was found in diabetic patients compared with non-diabetic patients (OR=1.31, 95% CI 1.09-1.55). On average, providers administered progressively more insulin with an additional 0.11U/h (95% CI=0.00-0.21] for every additional 10kg/m(2) of BMI and 0.20U/h (95% CI=0.01-0.39) less in diabetic patients than in non-diabetic patients. With the above practice pattern, the mean±SD of glucose level was 158±36mg/dL. Hypoglycemic (<60mg/dL) incident rate was 0.1% (9/8301 measurements) while hyperglycemic (>180mg/dL) incident rate was 28%. Glucose levels were within the target range (100-140mg/dL) only 28% of the time.


CONCLUSIONS
Low compliance and considerable variability in initiating and following institutional glucose management protocol were observed.
School of Medicine, University of Washington, Seattle, WA.
Katherine
K
Grunzweig
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. Electronic address: nairbg@uw.edu.
Bala G
BG
Nair
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Gene N
GN
Peterson
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Mayumi
M
Horibe
The-Mountain-Whisper-Light Statistics, Seattle, WA.
Moni B
MB
Neradilek
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Shu-Fang
SF
Newman
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Gail
G
Van Norman
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
Howard A
HA
Schwid
Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA.
Wei
W
Hao
Division of General Surgery, Department of Surgery, University of Washington, Seattle, WA.
E Patchen
EP
Dellinger
Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA.
Irl B
IB
Hirsch
D000046:Academic Medical Centers; D000368:Aged; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D000066491:Clinical Decision-Making / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control*; D007003:Hypoglycemia / Q000097:blood / Q000517:prevention & control*; D007328:Insulin / Q000097:blood / Q000627:therapeutic use; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
D001786:Blood Glucose; D007328:Insulin
Blood glucose; Institutional protocol; Intraoperative glucose; Surgery