PSUN218 The Impact of Mandatory Pre-Operative Endocrinology Outpatient Consultation Before Elective Surgery in Patients with Diabetes Mellitus
Authors: Can Ahmet Selcuk , Naran Jaya , Ghalib Neha , Risam Roople , LaFerla Caroline , Gaykovyy Alexander , Azzam Rami , Lavertue Samantha , Barnes Christopher , HaytoÄŸlu Tahir 
Published: November 2022

Abstract

Introduction
A multi-departmental quality improvement initiative by endocrinology, internal medicine, surgery, and anesthesia became effective, making it the standard of care to call for an outpatient endocrinology consult for diabetic patients undergoing elective surgery in our hospital.

Aim
We tested our hypothesis that mandatory endocrinology consults prior to elective surgery decreases negative outcome parameters in patients with poorly controlled diabetes. Material and Method: Patients with diabetes mellitus (T2DM) who had an HbA1C 8% and above and who were planned to have elective surgery were seen by Endocrinology Service as an outpatient before the surgery date and were cleared until fasting glucose is less than 200 mg/dl or HbA1c is less than 8%. Retrospective analysis of 64 inpatient elective T2DM surgical patients, with no endocrine consults from 09/2019-12/2019 (Group I), comparing with 51 inpatient elective T2DM surgical patients from 09/2020-12/2020, with endocrine consults prior to surgery (Group II). Exclusion criteria: Emergency surgical patients and patients who received endocrine consults prior to surgery from September – December 2019. Primary outcome measure: Average capillary glucose, length of stay (LOS), the number of patients with hypoglycemic episodes (&lt;70 mg/dl), hypoglycemia rate (number of glucose readings less than 70 mg/dl/the total number of capillary glucose measurements), readmission rate and infection rate. Mainly non-parametric statistical tests were utilized.

Results
There were 64 patients without endocrinology consult in 2019 (Group I) and 51 patients with endocrinology consult in 2020 (Group II). Although it was a mandatory policy, only 11 out of 51 patients were consulted to endocrinology. There was no difference in baseline characteristics of age, gender, average HbA1c, and type of surgery between the two groups. Average glucose during hospital stay, the number of patients who had hypoglycemia (13% versus 6%), average LOS, readmission within 30 days and postoperative infection rate were not statistically different between Group I and II. In Group I hypoglycemic events were 2% of all the capillary glucose measurements performed (17 hypoglycemia out of 852) and in Group II hypoglycemic events were %0.5 (3 out of 653) of all the capillary glucose measurements performed during surgical admission (p&lt;0.05). The number of hypoglycemic events were lower with preoperative endocrine consults. Limitations of this study include fewer elective surgeries in 2020 due to Covid-19.

Conclusion
The number of hypoglycemic events were lower in patients with diabetes and preoperative mandatory endocrinology consultation. There was no difference in average glucose, LOS, the number of subjects with hypoglycemia, readmission or infection rate. The study should be repeated after more education about mandatory preoperative endocrinology consults to surgeons is delivered and after the COVID pandemic is over, when there are no restrictions on elective surgery.
Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.