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

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

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.

Study Overview

• Status: Completed
• Conditions: Hyperglycemia; Diabetes Mellitus; Surgery
• Intervention / Treatment: Other: Exposure - postoperative hyperglycemia

• Study Type: Observational
• Enrollment (Actual): 7633

Contacts and Locations

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2N 4T9
      • Foothills Medical Centre

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All patients undergoing a surgical procedure at the Foothills Medical Centre who were admitted for at least 24-hours.

Description

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

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Diabetes with postoperative hyperglycemia; 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; Postoperative hyperglycemia (blood or capillary glucose > 10.0 mmol/L) within 72 hours of a surgical procedure
Diabetes without postoperative hyperglycemia; 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; 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; Postoperative hyperglycemia (blood or capillary glucose > 10.0 mmol/L) within 72 hours of a surgical procedure
No diabetes and no postoperative hyperglycemia; 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?

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)

Collaborators and Investigators

• Sponsor: University of Calgary

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2019
• Primary Completion (Actual): March 31, 2020
• Study Completion (Actual): March 31, 2020

Study Registration Dates

• First Submitted: December 11, 2020
• First Submitted That Met QC Criteria: December 16, 2020
• First Posted (Actual): December 22, 2020

Study Record Updates

• Last Update Posted (Actual): December 22, 2020
• Last Update Submitted That Met QC Criteria: December 16, 2020
• Last Verified: December 1, 2020

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Hyperglycemia
• Other Study ID Numbers: HREBA.CC-19-0157

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Data is available from the study principal investigator upon reasonable request.
• IPD Sharing Time Frame: Present for five years after study completion (March 31 2020).
• IPD Sharing Access Criteria: Email shannon.ruzycki@ucalgary.ca
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No