The Impact of Standardizing Preoperative Diabetic Medication Instruction and Glucose Optimization on Postoperative Patient Outcomes
Keywords:preoperative diabetes management, anesthesia preoperative evaluation
The purpose of this project was to evaluate the effectiveness of a standardized preoperative diabetic medication instruction program in patients with diabetes undergoing elective noncardiac surgical procedures. In particular, we measured postoperative blood glucose levels and surgical complication rates to assess the success of the program.
A retrospective review was performed on adult patients who were on oral hypoglycemic or insulin medication for diabetes mellitus type I and II, were undergoing elective non-cardiac surgery, and had been evaluated by the anesthesia preoperative clinic before and after standardization of medication instruction. Analysis was performed for the primary outcomes of postoperative glucose levels on post-op day 0 and secondary outcomes of surgical complications.
There were 167 patients in the pre-standardization protocol, and 183 patients in the post-standardization protocol, for a total of 350 patients. There was no significant difference between pre- and post-standardization protocols for postoperative glucose levels (158.5 ±63.22 vs. 154.3 ±56.32, P=0.52) nor secondary outcomes such as time to discharge in days (4.79 ±0.95 vs. 4.55 ±0.94, P=0.73), postoperative surgical site infection (odds ratio [OR], 13.77; 95% confidence interval [CI], [0.40, 471.1]), postoperative infection (OR=0.62; 95% CI [0.22, 1.73]), diabetes complications such as diabetic ketoacidosis or hyperglycemic hyperosmolar syndrome (OR=1.29; 95% CI [0.04, 43.08]), readmission to the hospital within 30-days (OR=1.15; 95% CI [0.40, 43.08]), and return to the operating room (OR=0.61; 95% CI [0.21, 1.73]).
There is no statistically significant difference in the measured perioperative outcomes before and after the standardization of preoperative diabetic medication instruction. This is most likely due to a low observation of surgical complications. Future studies may include larger populations to further evaluate the efficacy of a standardized preoperative diabetic medication instruction program.
Copyright (c) 2023 Olivia Calisi, Gilles Dongmo, Selina Read
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright, simultaneously licensing their works under a Creative Commons Attribution 4.0 International License (CC BY 4.0). That license allows others to share and adapt the work so long as they provide reasonable attribution. This license applies to the submitted version of the work (preprint), the accepted version of the work (postprint), and the final published version.
Ideal attribution for a work published in this journal consists of the work’s title, the title of the journal, the name(s) of the author(s), the DOI (digital object identifier), and a link to the CC BY 4.0 license deed. The journal encourages those relying on the CC BY 4.0 license to consult the Best Practices for Attribution on the Creative Commons wiki.
As they retain copyright, authors are entitled to distribute any version of the article and to grant other licenses to use the work, subject to the CC BY 4.0 license. The journal encourages authors to include the ideal attribution described above when they distribute their works after acceptance by the journal.
Authors are encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and after publication, as it can lead to productive exchanges, as well as earlier and greater citation of published work (see SPARC's "Open Access" article).