Quality Gaps in Screening and Monitoring for Postoperative Hyperglycemia in a Canadian Hospital

Study Overview
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Brief Summary
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Patients with and without diabetes who have postoperative hyperglycemia have worse outcomes than patients with in-target blood sugars. Previous quality improvement work suggests numerous barriers and clinical inertia may contribute to quality gaps in glycemic management for surgical patients. Using a framework for perioperative glycemic management, we sought to measure quality gaps in perioperative glycemic care. This cross-sectional study used administrative data to measure the proportion of surgical patients with and without known diabetes who underwent preoperative hemoglobin A1c measurement, postoperative point-of-care testing for glucose (POCT), had hyperglycemia, and received basal bolus insulin regimens for treatment. We performed an exploratory analysis comparing length of stay (LOS) in patients with and without diabetes who had and did not have postoperative hyperglycemia.

Official Title
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Quality Gaps in Screening and Monitoring for Postoperative Hyperglycemia in a Canadian Hospital: A Cross-sectional, Exploratory Study

Conditions
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Diabetes Mellitus, Surgery, Hyperglycemia

Intervention / Treatment
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* Other: Exposure - postoperative hyperglycemia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Underwent inpatient surgical procedure at the Foothills Medical Centre between Apr 1 2019 and March 31 2020 Stayed in hospital for more than 24-hours after surgery Exclusion Criteria: Younger than 18 years of age

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Diabetes with postoperative hyperglycemia<br>Patients with known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who had postoperative hyperglycemia (point of care test > 10.0 mmol/L). | Other: Exposure - postoperative hyperglycemia<br>* Postoperative hyperglycemia (blood or capillary glucose > 10.0 mmol/L) within 72 hours of a surgical procedure<br>|
| Diabetes without postoperative hyperglycemia<br>Patients with known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who did not have postoperative hyperglycemia (point of care test > 10.0 mmol/L). | |
| No diabetes with postoperative hyperglycemia<br>Patients without known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who had postoperative hyperglycemia (point of care test > 10.0 mmol/L). | Other: Exposure - postoperative hyperglycemia<br>* Postoperative hyperglycemia (blood or capillary glucose > 10.0 mmol/L) within 72 hours of a surgical procedure<br>|
| No diabetes and no postoperative hyperglycemia<br>Patients without known diabetes (Discharge Abstract Database or hemoglobin A1c > 6.5%) who did not have postoperative hyperglycemia (point of care test > 10.0 mmol/L). | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of point of care blood glucose measurements in 24-hours after surgery |  | 24-hours post surgery | 
| Proportion of patients who have hyperglycemia | blood or capillary glucose > 10 mmol/L | 24-hours after surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Proportion of patients who have moderate hyperglycemia | blood or capillary glucose 14.0-17.9 mmol/L | 24-hours after surgery | 
| Proportion of patients who have severe hyperglycemia | blood or capillary glucose > 18.0 mmol/L | 24-hours after surgery | 
| Hospital Length of stay | Hospital length of stay (days) | Until study completion (up to one year from surgical procedure) |