Abstract
Background Ten percent of elective surgical patients have diabetes. These patients demonstrate excess perioperative morbidity and mortality. National guidance on the management of adults with diabetes undergoing surgery was published in 2011. We present a region-wide audit of adherence to this guidance across the North Western Deanery. Methods Local teams prospectively collected data according to a locally approved protocol. Pregnant, paediatric and non-elective patients were excluded from this audit. Patient characteristics, type of surgery and aspects of perioperative management were collated and centrally analysed against audit criteria based upon national recommendations. Results 247 patients with diabetes were identified. HbA1c was recorded in 71% of patients preoperatively; 9% of patients with an abnormal HbA1c were not known by, or referred to, the diabetes team. 17% of patients were admitted the evening preceding surgery. The mean fasting time was 12:20(4) h. Variable rate i.v. insulin infusions (VRIII) were not used when indicated in 11%. Only 8% of patients received the recommended substrate fluid, along with the VRIII (5% glucose in 0.45% saline). Intra-operative capillary blood glucose (CBG) was measured hourly in 56% of patients. Intra-operative CBG was within the acceptable range (4-12 mmol.L-1) in 85% of patients. 73% of patients had a CBG measurement performed in recovery. The WHO checklist was used in 95% of patients. Conclusions National perioperative guidelines were not adhered to in a substantial proportion of patients with diabetes undergoing elective surgery. This study represents a template for future trainee networks.
| Original language | English |
|---|---|
| Pages (from-to) | 501-506 |
| Number of pages | 6 |
| Journal | British Journal of Anaesthesia |
| Volume | 116 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 1 Apr 2016 |
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Keywords
- anaesthesia
- clinical audit
- diabetes mellitus
- perioperative care
- surgical procedures, elective
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
Cite this
Perioperative management of diabetes in elective patients : A region-wide audit. / Jackson, M. J.; Patvardhan, C.; Wallace, F.; Martin, A.; Yusuff, H.; Briggs, G.; Malik, Rayaz.
In: British Journal of Anaesthesia, Vol. 116, No. 4, 01.04.2016, p. 501-506.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Perioperative management of diabetes in elective patients
T2 - A region-wide audit
AU - Jackson, M. J.
AU - Patvardhan, C.
AU - Wallace, F.
AU - Martin, A.
AU - Yusuff, H.
AU - Briggs, G.
AU - Malik, Rayaz
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Background Ten percent of elective surgical patients have diabetes. These patients demonstrate excess perioperative morbidity and mortality. National guidance on the management of adults with diabetes undergoing surgery was published in 2011. We present a region-wide audit of adherence to this guidance across the North Western Deanery. Methods Local teams prospectively collected data according to a locally approved protocol. Pregnant, paediatric and non-elective patients were excluded from this audit. Patient characteristics, type of surgery and aspects of perioperative management were collated and centrally analysed against audit criteria based upon national recommendations. Results 247 patients with diabetes were identified. HbA1c was recorded in 71% of patients preoperatively; 9% of patients with an abnormal HbA1c were not known by, or referred to, the diabetes team. 17% of patients were admitted the evening preceding surgery. The mean fasting time was 12:20(4) h. Variable rate i.v. insulin infusions (VRIII) were not used when indicated in 11%. Only 8% of patients received the recommended substrate fluid, along with the VRIII (5% glucose in 0.45% saline). Intra-operative capillary blood glucose (CBG) was measured hourly in 56% of patients. Intra-operative CBG was within the acceptable range (4-12 mmol.L-1) in 85% of patients. 73% of patients had a CBG measurement performed in recovery. The WHO checklist was used in 95% of patients. Conclusions National perioperative guidelines were not adhered to in a substantial proportion of patients with diabetes undergoing elective surgery. This study represents a template for future trainee networks.
AB - Background Ten percent of elective surgical patients have diabetes. These patients demonstrate excess perioperative morbidity and mortality. National guidance on the management of adults with diabetes undergoing surgery was published in 2011. We present a region-wide audit of adherence to this guidance across the North Western Deanery. Methods Local teams prospectively collected data according to a locally approved protocol. Pregnant, paediatric and non-elective patients were excluded from this audit. Patient characteristics, type of surgery and aspects of perioperative management were collated and centrally analysed against audit criteria based upon national recommendations. Results 247 patients with diabetes were identified. HbA1c was recorded in 71% of patients preoperatively; 9% of patients with an abnormal HbA1c were not known by, or referred to, the diabetes team. 17% of patients were admitted the evening preceding surgery. The mean fasting time was 12:20(4) h. Variable rate i.v. insulin infusions (VRIII) were not used when indicated in 11%. Only 8% of patients received the recommended substrate fluid, along with the VRIII (5% glucose in 0.45% saline). Intra-operative capillary blood glucose (CBG) was measured hourly in 56% of patients. Intra-operative CBG was within the acceptable range (4-12 mmol.L-1) in 85% of patients. 73% of patients had a CBG measurement performed in recovery. The WHO checklist was used in 95% of patients. Conclusions National perioperative guidelines were not adhered to in a substantial proportion of patients with diabetes undergoing elective surgery. This study represents a template for future trainee networks.
KW - anaesthesia
KW - clinical audit
KW - diabetes mellitus
KW - perioperative care
KW - surgical procedures, elective
UR - http://www.scopus.com/inward/record.url?scp=84963858059&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84963858059&partnerID=8YFLogxK
U2 - 10.1093/bja/aev554
DO - 10.1093/bja/aev554
M3 - Article
VL - 116
SP - 501
EP - 506
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
SN - 0007-0912
IS - 4
ER -