Development and Implementation of a Perioperative Blood Glucose Monitoring Protocol for Patients Undergoing Spinal Surgery

Abstract

PurposeStress-induced hyperglycemia during the perioperative period is associated with adverse outcomes after spinal surgery, which increases both patient-related burden and hospital costs. This quality improvement project describes the development and implementation of a perioperative blood glucose monitoring protocol for patients undergoing spinal surgery. DesignAn evidence-based perioperative blood glucose monitoring protocol was developed by a multidisciplinary committee of specialists in endocrinology and anesthesiology with utilization of the American Diabetes Association diabetes screening criteria. MethodsThe protocol was implemented in the perioperative areas of a regional hospital in the Southeastern United States. The project sample included patients with and without a prior diagnosis of diabetes who met protocol inclusion criteria during a 3-month implementation period. FindingsPreoperative glycated hemoglobin (HbA1c) testing identified more than 54% of previously undiagnosed patients with levels consistent with either prediabetes or diabetes according to the American Diabetes Association criteria for diagnosis. Patients with diabetes and those without diabetes experienced a perioperative increase in blood glucose with levels remaining elevated above preoperative baseline through postoperative day 1. ConclusionsA perioperative blood glucose monitoring protocol enables preoperative identification of patients with undiagnosed prediabetes and diabetes, allowing for optimization before elective surgery and establishment of appropriate postoperative follow-up care. In addition, a blood glucose monitoring protocol increases the detection of perioperative hyperglycemia and may lead to a reduction in postoperative complications after spinal surgery.