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| Ambulatory Surgery Diabetic Pathway for Low Risk Procedures |
| Jonas Harley & Garret Weber Westchester Medical Center, Valhalla, NY, United States |
BACKGROUND: Optimization of preoperative glucose levels remains one of the top considerations for patients undergoing surgery. Many institutions are developing pathways to assist with management of glucose values and how to proceed in the patient’s best interest. Westchester Medical Center has implemented one such guideline for low risk surgeries in patients where glycemic management is not expected to affect the patient’s recovery. PURPOSE: Preoperative considerations: All NPO diabetics should have a preoperative glucose check The patient is expected to return home The procedure is a low risk surgery (Examples: eye surgery, breast biopsy) If glucose levels are >300 and the patient is having intermediate risk surgery (Example: joint replacement) consider postponement for better outcomes. The patient is not actively in hyperglycemic hyperosmolar non-ketotic syndrome (HHNS) or diabetic ketoacidosis (DKA) If patient is symptomatic or suspicion of above, then can obtain: urine ketones/ beta-hydroxybutyrate and metabolic panel to check for acidosis Different methods (GA, regional, MAC) of anesthesia are not included in risk calculations If glucose is >300 then: Consider treating with subcutaneous sliding scale insulin Check sugar every 2 hours Intraoperative: Continue q2h glucose check and treatment with as needed sliding scale insulin Avoid dexamethasone if no significant risk of postoperative nausea and vomiting Postoperative: NPO diabetics should have a postoperative glucose check Assuming glucose levels are at baseline, no specific glucose value needed to allow patient to be discharged Patients are provided verbal and written education regarding the importance of glycemic control and follow up RESULTS: The aforementioned pathway has provided a clearly defined expectation for proceeding with low risk surgeries even in patients with significantly elevated glucose levels. CONCLUSIONS: This is a useful tool in maintaining a high standard of care while allowing necessary and beneficial surgeries to proceed. |