Preoperative Diabetes Management for Patients Undergoing Elective Surgeries at a Veterans Affairs Medical Center

Preoperative hyperglycemia or hypoglycemia can result in surgical delays, cancellations, and/or postoperative complications, which can lead to increased costs and worsened patient outcomes. This retrospective study conducted at Veteran Health Indiana (VHI) assessed the level of preoperative glycemic control in patients undergoing major elective surgical procedures to determine what, if any, standardization exists for perioperative diabetes mellitus (DM) management and its impact on patient outcomes.

A retrospective chart review of 394 elective surgeries involving patients with DM from January 1, 2018, to December 31, 2021, at VHI was conducted. The primary end point was the incidence of patients with preoperative blood glucose > 180 mg/dL or < 70 mg/dL who had surgical procedures delayed or canceled due to hyperglycemia or hypoglycemia. Postoperative complications were examined for safety outcomes.

A randomized sample of 131 surgeries was reviewed and included. The mean preoperative blood glucose level was 146 mg/dL; no surgical procedures delayed or canceled due to hyperglycemia or hypoglycemia. All communication for preoperative DM medication management came from surgical service letters. This identified 122 cases (93.1%). Only 30 patients (24.6%) received instructions specifically tailored to their regimen. The most frequently observed postoperative complication was acute kidney injury (8.4%).

Based on this randomized sample, the current VHI practice of providing a presurgery clinic visit and perioperative DM medication instructions is effective for preventing delays or cancellations in elective surgeries.