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Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons Massachusetts Chapter of the American College of Surgeons
56th Annual Meeting Abstracts


Presentation # 3

Abstract Title

Compliance with the Surgical Care Improvement Project (SCIP) results in Improved Cardiac Surgery Out

Author Block

Paresh Mane MD, Afshin Ehsan MD

Tufts Medical Center, Boston, MA

Abstract Body

Background: The Surgical Care Improvement Project is a national quality improvement project whose aim was to reduce surgical complications by 25% by the year 2010. It has outlined specific outcome measures in 6 different areas. One of the outcomes measured is glucose levels of cardiac surgery patients with a goal of < 200mg/dL on postoperative days 1 and 2. We will describe our service-based experience in achieving this goal.
Methods: This was a retrospective review of glucose management in cardiac surgical patients. A multidisciplinary team met regularly to implement best practices and developed standardization of process. The team included representatives from the pre, peri, and postoperative areas caring for these patients. Pivotal changes were starting insulin infusions earlier, narrowing the goal range of the hyperglycemia protocol, increasing the number of measurements taken, and developing a transitional protocol for subcutaneous glucose management.

Results: Overall SCIP compliance improved from 73% (216/294) to 93% (304/327) (p<0.0001) over a two year period. Average glucose levels in the Cardiac Surgery ICU fell from 15259 to 14457 over a 2 year period (p<0.0001) without an increase in the incidence of severe hypoglycemic (blood sugar < 40) episodes (0.3% (42/11521) vs. 0.3% (62/18244)). There was a nearly two-fold increase in the total number of glucose measurements from 2007 (11521) to 2009 (18244). These improvements resulted in a decrease in the rate of surgical site infections (4.97% (18/362) vs. 2.78% (14/504)).

Conclusions: Our experience was that blood glucose <200 mg/dL on postoperative days 1 and 2 were achievable through a multidisciplinary management approach across the continuum of care. Improvement in this SCIP metric resulted in reduced surgical site infections.

 

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