Perioperative Hyperglycemia Prevention for Patients Undergoing Colorectal Surgery

BACKGROUND: Perioperative hyperglycemia (blood glucose [BG] > 200 mg/dL) occurs in 20-40% of patients who undergo any surgical procedure. Perioperative hyperglycemia among colorectal surgery patients correlates with increased anastomotic leakage and surgical site infections. Studies show that a perioperative glycemic protocol with regular assessment of intraoperative BG levels decreases the risk of postoperative hyperglycemia.

LOCAL PROBLEM: The setting for this project was an academic medical center. The population included patients having colorectal surgery with anastomosis of the bowel. The project site uses a bowel protocol that specifies perioperative BG < 200 mg/dL. The frequency of intraoperative BG checks was not specified within the protocol. The purpose was to decrease postoperative hyperglycemia, aiming for a 50% decrease within 4 months.

METHODS: The EBPI model was used to guide this project. An intraoperative glycemic protocol was adapted from the literature and implemented, and educational sessions were conducted via email and in-person. Preoperative nurse training was completed to educate the staff about the bowel protocol details. PDSA (plan-do-study-act) cycles were used to assess the effect of our education with protocol compliance, as well as the effect of the protocol on postoperative hyperglycemia.

INTERVENTIONS: The intraoperative glycemic protocol specified the frequency of BG checks and provided an algorithm for treatment. Anesthesia providers (APs) were the participants who utilized the protocol. Additionally, preoperative nurses were trained to check a BG on every colorectal surgery patient, per the stated protocol.

RESULTS: Protocol compliance rates increased from 48.08% to 60.27% post-implementation. Postoperative hyperglycemia decreased from 6.12% to 4.84%.

CONCLUSIONS: The 40% decrease in the postoperative hyperglycemia rate was not statistically significant. Our interventions identified multiple barriers for intraoperative glycemic control for APs. Granting access to the necessary equipment and resources may decrease perioperative hyperglycemia and improve intraoperative compliance and patient outcomes.