Perioperative Glucose Management to Reduce Surgical Site Infections: Clinical Practice Guideline

Abstract

Background: The association of hyperglycemia during and after surgery has been shown to increase the risk of surgical site infections in multiple surgical specialties. Patients with poorly controlled blood glucose levels are at higher risk for surgical site infections and are commonly predisposed to post-op soft tissue and bone healing complications. Maintaining blood glucose values < 140 mg/dL demonstrated a stronger link to reducing rates of surgical site infections and other postoperative outcomes. Local Problem: The purpose of this project is to develop a clinical practice guideline that provides clear directions and constitutes best practice strategies for the management of hyperglycemia throughout the perioperative period of adult patients undergoing surgery at a tertiary medical facility in Maryland. This facility identified a rise in the incidence of post-op hyperglycemia with blood glucose levels ≥ 180 mg/dl and an increase in post-op surgical site infections in their patient population. Interventions: This project took place in three phases over a 14-week period. The first phase included recruitment of an expert panel consisting of an anesthesiologist and Certified Registered Nurse Anesthetist. After project buy-in, a draft of the guideline was presented to the panel. They reviewed and graded the guideline draft using the AGREE II Tool. Revisions were made based on the panel’s recommendations and AGREE II results. In phase two, a final meeting was held with the chief anesthesiologist for feedback and approval of the final presentation to the anesthesia providers. In phase three, a brief formal presentation was given to the anesthesia department. Anesthesia providers were asked to rate the guideline using the Provider Feedback Questionnaire. The data collected from the Provider Feedback Questionnaire surveys were analyzed and results were obtained to make final changes to the guideline. Results: The guideline provided clear instructions, produced positive patient outcomes, and was deemed favorable by the anesthesia department. Some providers felt the financial implications would hinder implementation, while others were unsure of changing their practice due to the rigid guidelines. Conclusions: This guideline was successfully developed and implemented at the requesting institution with the support of key stakeholders. Monitoring and managing hyperglycemic blood glucose levels in the perioperative period can decrease the incidence of postoperative surgical site infections.