An outcomes model for assessing the effects of an intensive perioperative glycemic control protocol for patients with diabetes undergoing CABG

2.50
Hdl Handle:
http://hdl.handle.net/10755/163704
Category:
Abstract
Type:
Presentation
Title:
An outcomes model for assessing the effects of an intensive perioperative glycemic control protocol for patients with diabetes undergoing CABG
Author(s):
Polomano, Rosemary; Eddinger, Victoria L.; Gabbay, Robert A.
Author Details:
Rosemary Polomano, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA, email: rpolomano@psu.edu; Victoria L. Eddinger; Robert A. Gabbay
Abstract:
Purpose: The purpose of this study was to test the effectiveness of interdisciplinary clinical practice guidelines for intensive perioperative glucose management by developing an outcomes model for diabetic patients undergoing coronary artery by-pass graft (CABG). Specific Aims: To measure the effects of strict perioperative glycemic control in diabetic patients undergoing CABG surgery on blood glucose levels, length of hospitalization and the development of deep sternal wound (DSW) infections. To assess costs associated with glycemic control. Framework: Because the mortality rate for diabetics undergoing CABG surgery is double that of all non-diabetics and the risk of DSW infection is 2.7 times higher, an outcomes model was employed to evaluate clinical outcomes and costs. Methods: Outcomes from a retrospective cohort of patients with diabetes undergoing CABG surgery at the Milton S. Hershey Medical Center from January 1999 to December 1999 (pre-insulin protocol, n=81) were compared to patients (n=107) managed by an Intensive Glycemic Control Protocol (IGCP) from January 2000 to December 2000. IV insulin infusion with glucose monitoring was initiated to maintain glucose levels between 120-200 mg/dl. Primary outcome measures included average blood glucose levels, cost of hospitalization, length of hospital stay (LOS), and DSW infections. Differences in glucose levels were tested between patients receiving the ICGP using repeated measured analysis of variance. Univariate comparisons of LOS and costs were tested using Student's t test with multivariate comparisons to determine the incremental effect of increased glucose levels on costs and LOS. Differences in proportions of patients with DSW infections were tested using a Chi-square. Results and Conclusions: There was a non-significant trend towards reduction in cost of care for patients receiving the IGCP. A histogram for glucose levels pre- and post-IGCP suggests better control and lower glucose values with the ICGP. Even though the average number of glucose measurements was almost 3 times greater for the IGCP, there was a nonsignificant decreasing trend towards reduction in cost of care, LOS and DSW infections for this group. We conclude that our IGCP improved perioperative glycemic control in diabetic patients undergoing CABG surgery, which resulted in revenue neutral outcomes. Implications for Nursing Practice: Interdisciplinary practice guidelines for intensive glycemic control are associated with improvements in glucose management and postoperative outcomes.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleAn outcomes model for assessing the effects of an intensive perioperative glycemic control protocol for patients with diabetes undergoing CABGen_GB
dc.contributor.authorPolomano, Rosemaryen_US
dc.contributor.authorEddinger, Victoria L.en_US
dc.contributor.authorGabbay, Robert A.en_US
dc.author.detailsRosemary Polomano, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA, email: rpolomano@psu.edu; Victoria L. Eddinger; Robert A. Gabbayen_US
dc.identifier.urihttp://hdl.handle.net/10755/163704-
dc.description.abstractPurpose: The purpose of this study was to test the effectiveness of interdisciplinary clinical practice guidelines for intensive perioperative glucose management by developing an outcomes model for diabetic patients undergoing coronary artery by-pass graft (CABG). Specific Aims: To measure the effects of strict perioperative glycemic control in diabetic patients undergoing CABG surgery on blood glucose levels, length of hospitalization and the development of deep sternal wound (DSW) infections. To assess costs associated with glycemic control. Framework: Because the mortality rate for diabetics undergoing CABG surgery is double that of all non-diabetics and the risk of DSW infection is 2.7 times higher, an outcomes model was employed to evaluate clinical outcomes and costs. Methods: Outcomes from a retrospective cohort of patients with diabetes undergoing CABG surgery at the Milton S. Hershey Medical Center from January 1999 to December 1999 (pre-insulin protocol, n=81) were compared to patients (n=107) managed by an Intensive Glycemic Control Protocol (IGCP) from January 2000 to December 2000. IV insulin infusion with glucose monitoring was initiated to maintain glucose levels between 120-200 mg/dl. Primary outcome measures included average blood glucose levels, cost of hospitalization, length of hospital stay (LOS), and DSW infections. Differences in glucose levels were tested between patients receiving the ICGP using repeated measured analysis of variance. Univariate comparisons of LOS and costs were tested using Student's t test with multivariate comparisons to determine the incremental effect of increased glucose levels on costs and LOS. Differences in proportions of patients with DSW infections were tested using a Chi-square. Results and Conclusions: There was a non-significant trend towards reduction in cost of care for patients receiving the IGCP. A histogram for glucose levels pre- and post-IGCP suggests better control and lower glucose values with the ICGP. Even though the average number of glucose measurements was almost 3 times greater for the IGCP, there was a nonsignificant decreasing trend towards reduction in cost of care, LOS and DSW infections for this group. We conclude that our IGCP improved perioperative glycemic control in diabetic patients undergoing CABG surgery, which resulted in revenue neutral outcomes. Implications for Nursing Practice: Interdisciplinary practice guidelines for intensive glycemic control are associated with improvements in glucose management and postoperative outcomes.en_GB
dc.date.available2011-10-27T11:12:21Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:12:21Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.