Perioperative management of diabetes in elective patients: a region-wide audit

M J Jackson, C Patvardhan, F Wallace, A Martin, H Yusuff, G Briggs, Rayaz Malik, NWRAG Peri-Op Diabetes Audit Group

Research output: Contribution to journalArticlepeer-review

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 languageEnglish
Pages (from-to)501-506
Number of pages6
JournalBritish Journal of Anaesthesia
Volume116
Issue number4
Early online date11 Feb 2016
DOIs
Publication statusPublished - Apr 2016

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose
  • Diabetes Mellitus
  • Elective Surgical Procedures
  • Female
  • Great Britain
  • Guideline Adherence
  • Hemoglobin A, Glycosylated
  • Humans
  • Hypoglycemic Agents
  • Insulin
  • Intraoperative Complications
  • Male
  • Medical Audit
  • Middle Aged
  • Monitoring, Intraoperative
  • Perioperative Care
  • Postoperative Complications
  • Prospective Studies
  • Young Adult
  • Journal Article

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