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DIABETES affects: CONCLUSIONS
OPTIMIZATION OF ADULT DIABETIC PATIENTS UNDERGOING ELECTIVE SURGERY; AN AUDIT OF PERI-OPERTIVE BLOOD GLUCOSE MONITORING, MANAGEMENT AND IMPACT ON RECOVERY Abbas Majeed1, Aeliya Zaidi2, Valerie Hilton1 Royal Glamorgan Hospital, Llantristant1 University Hospital of Wales, Cardiff2 CLINICAL AUDIT Prospective data collection. Over a three weeks period Data of 28 patients was collected for pre-operative/ intra-operative/ post operative blood glucose monitoring and management in the theatre and recovery, before the patient is returned back to the ward DIABETES affects: 4-5% of general UK population 10% of the patients undergoing surgical procedures. Poorly controlled diabetes can affect: Post operative recovery Length of hospital stay Morbidity Mortality RESULTS 23 patients were male. Median age was 66.3 years(range years). Only 2 patients were Type I Diabetic and % type II DM. 10.8% had no HbA1c assessment done within the preceding one year. A perioperative mortality rate ≥50% reported as compared to non diabetic population. Clinically safe outcome for the patient: Pre-operative assessment Optimisation of the patient Peri and intra-operative management Precise post operative planning No patient required intra-operative VRIII. All patients had BM checked in the recovery post-op. 2 patients required VRIII restarting. 10 patients had pre-op HbA1c>69mmol/mol; 5 of these had post op sepsis; 2 HAP, 1 Urosepsis and 2 wound infection. No 30 day mortality CONCLUSIONS Monitoring HbA1c; elective patients should have HbA1c < 69mmol/mol before elective surgery. Prioritisation for diabetic patients on list. Continuation of sliding scale intra op along with substrate infusion and recording CBG. Post op action plan for all diabetic patients should be documented in the patients anaesthetic chart. Optimization of the patients preoperatively can help avoid post op complications and ensure uneventful recover REFERENCES 1. NHS Diabetes. Findings from the National Diabetes Inpatient Audit (NaDIA) 2010. 2011 2. Frisch A, Chandra P, Smiley D, Peng L, Rizzo M, Gatcliffe C et al.Prevalence and clinical outcome of hyperglycaemia in the perioperative period in non cardiac surgery. Diabetes Care 2010; 33: 1783–1788
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