Day-of-surgery quality gaps in glycemic management: a retrospective cohort study

Perioperative hyperglycemia is associated with worse patient outcomes. Characterizing quality gaps in day-of-surgery glucose management can guide quality improvement teams to address this risk factor for infection, readmission, and death.

This retrospective cohort study used administrative and electronic health record data to describe process, outcome, and balancing measures of day-of-surgery glycemic management for adult patients with and without diabetes undergoing surgery at 6 hospitals in Alberta, Canada between 2019 and 2024. Participants were stratified by diabetes, prediabetes, no diabetes and unknown diabetes status. We report the association between hyperglycemia (blood glucose ≥ 10.0 mmol.L^-1) and length of stay, admission to ICU, and 30-day readmissions as an exploratory analysis.

There were 12,275 eligible procedures including 3,164 procedures performed on patients with diabetes (25.8%). Of patients with diabetes, 85.4% (n = 2,703) had at least one glucose measurement on the day of surgery and 37.1% (n = 1,004) had hyperglycemia. About half of patients with diabetes and hyperglycemia received insulin (51.4%, n = 516). More than 10% of patients with prediabetes, no diabetes, and unknown diabetes status had hyperglycemia and less than 20% received insulin. Patients with hyperglycemia on the day of surgery had longer length of stay (4.49 days; 95% CI 4.70 to 5.18 days; p < 0.0001), postoperative ICU admission (aOR 5.37; 95% CI 4.45-6.49; p < 0.001) and odds of 30-day readmission (aOR 2.19; 95% CI 1.89-2.54; p < 0.0001).

There were important quality gaps in glucose measurement and hyperglycemia treatment for patients with diabetes. Hyperglycemia was common and clinically significant among patients without diabetes. Future work to understand the prevalence of hyperglycemia in patients without diabetes and to address quality gaps in day-of-surgery glucose measurement are needed.