Damien J LaPar1, James M Isbell1, John A Kern1, Gorav Ailawadi1, Irving L Kron2. 1. Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va. 2. Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va. Electronic address: ilk@virginia.edu.
Abstract
OBJECTIVE: The current Surgical Care Improvement Project (SCIP) measure for controlled postoperative 6-am glycemic control after cardiac surgery identifies those with blood glucose levels of ≤200 mg/dL. The purpose of the present study was to evaluate the effect of achieving this SCIP measure on risk-adjusted postoperative cardiac surgical outcomes. METHODS: The data were analyzed for all cardiac surgery patients from a single institution (June 2010 to August 2012). The patients were categorized by the postoperative 6-am glucose levels into 2 SCIP measure cohorts: SCIP (≤200 mg/dL) versus non-SCIP (>200 mg/dL). Propensity-matched cohort comparisons and multiple regression analyses assessed the associations between SCIP measure compliance and the risk-adjusted outcomes. RESULTS: Of 1703 patients, 1527 (90%) achieved SCIP measure glycemic control. Preoperative diabetes was more common among the non-SCIP patients (P < .001); the median Society of Thoracic Surgeons-predicted mortality (P = .14) was similar between the 2 groups. No significant differences were observed in major morbidity, mortality, or resource usage among the propensity-matched cohorts. After adjustment for Society of Thoracic Surgeons-predicted risk, non-SCIP status was not associated with increased mortality (P = .44), composite major morbidity (P = .16), major sternal complications (P = .68), total intensive care unit duration (P = .70), or postoperative length of stay (P = .27). Similar risk-adjusted results were estimated for patients undergoing isolated coronary artery bypass grafting. CONCLUSIONS: Achieving the SCIP measure for controlled postoperative 6-am blood glucose levels ≤200 mg/dL after cardiac surgery was not associated with improved risk-adjusted mortality, morbidity, or hospital resource usage. These data suggest that this metric might not be a valid measure of postoperative cardiac surgical quality.
OBJECTIVE: The current Surgical Care Improvement Project (SCIP) measure for controlled postoperative 6-am glycemic control after cardiac surgery identifies those with blood glucose levels of ≤200 mg/dL. The purpose of the present study was to evaluate the effect of achieving this SCIP measure on risk-adjusted postoperative cardiac surgical outcomes. METHODS: The data were analyzed for all cardiac surgery patients from a single institution (June 2010 to August 2012). The patients were categorized by the postoperative 6-am glucose levels into 2 SCIP measure cohorts: SCIP (≤200 mg/dL) versus non-SCIP (>200 mg/dL). Propensity-matched cohort comparisons and multiple regression analyses assessed the associations between SCIP measure compliance and the risk-adjusted outcomes. RESULTS: Of 1703 patients, 1527 (90%) achieved SCIP measure glycemic control. Preoperative diabetes was more common among the non-SCIP patients (P < .001); the median Society of Thoracic Surgeons-predicted mortality (P = .14) was similar between the 2 groups. No significant differences were observed in major morbidity, mortality, or resource usage among the propensity-matched cohorts. After adjustment for Society of Thoracic Surgeons-predicted risk, non-SCIP status was not associated with increased mortality (P = .44), composite major morbidity (P = .16), major sternal complications (P = .68), total intensive care unit duration (P = .70), or postoperative length of stay (P = .27). Similar risk-adjusted results were estimated for patients undergoing isolated coronary artery bypass grafting. CONCLUSIONS: Achieving the SCIP measure for controlled postoperative 6-am blood glucose levels ≤200 mg/dL after cardiac surgery was not associated with improved risk-adjusted mortality, morbidity, or hospital resource usage. These data suggest that this metric might not be a valid measure of postoperative cardiac surgical quality.
Authors: Joseph A Hyder; Jonathan Niconchuk; Laurent G Glance; Mark D Neuman; Robert R Cima; Richard P Dutton; Louis L Nguyen; Lee A Fleisher; Angela M Bader Journal: Anesth Analg Date: 2015-02 Impact factor: 5.108
Authors: Luciana Vládia Carvalhêdo Fragoso; Márcio Flávio Moura de Araújo; Lidianne Fernandes da Silva Lobo; Dirk Schreen; Maria Lúcia Zanetti; Marta Maria Coelho Damasceno Journal: Einstein (Sao Paulo) Date: 2022-06-01