Perioperative Glucose Control in Vascular Patients via Implementation of a Standard Perioperative Glucose Protocol

Perioperative hyperglycemia is associated with increased morbidity, mortality, and health care costs in patients with diabetes undergoing vascular surgery. The aim of this quality improvement project was to implement a standardized perioperative glucose control protocol (PGCP) to improve glycemic monitoring and management in this population.

The project utilized the Model for Improvement framework and a Plan-Do-Study-Act cycle to assess the effectiveness of the PGCP in a tertiary referral Veterans Affairs (VA) hospital over a 90-day period.

Pre and postimplementation data were collected on glycemic control, protocol adherence, and postoperative outcomes. Statistical analysis included χ² tests and t tests to compare categorical and continuous variables, respectively.

Implementation of the PGCP significantly increased intraoperative blood glucose monitoring (31% to 93%, P < .001), preoperative hyperglycemia treatment (0% to 100%, P = .002), intraoperative hyperglycemia treatment (40% to 100%, P = .018, and postoperative hyperglycemia treatment (0% to 75%, P = .007). Trends toward reduced surgical site infections (8.8% to 3.3%) and 30-day mortality (5.7% to 0%) were observed, though these were not statistically significant.

Findings suggest that a standardized PGCP improves perioperative glycemic control and adherence to monitoring protocols. Future studies with larger sample sizes and broader implementation may further validate the impact of standardized glycemic management on surgical outcomes in patients with diabetes undergoing vascular procedures.