Authors (including presenting author) :
Liu CHJ (1), Chu HMM (1), Chan CS (1)
Affiliation :
Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
Diabetes Mellituts (DM) is affecting 10-15% of surgical patients internationally. It has been shown that DM is associated with increased perioperative morbidity and mortality. The perioperative control of serum glucose level is therefore crucial for patient outcome. Certain international guidelines including one by UK were available but there is no local guideline regarding the corresponding management. We would like to see how much our practices were deviated from the international guidelines.
Objectives :
To audit our perioperative management on elective surgical patients with diabetes according to AAGBI guidelines 2015 and to compared our practices to the Region-Wide audit in UK in 2016
Methodology :
This was a retrospective audit. Diabetic patients undergoing surgeries in November 2020 were identified in CDAS and details were retrieved from CMS. The data were analysed and compared with the AAGBI guidelines on Perioperative Management of the Surgical Patients with Diabetes in 2015 and an audit on the compliance to the guidelines in UK in 2016 respectively.
Result & Outcome :
78 diabetic patients undergoing elective surgeries were identified. HbA1c within 3 months were recorded in 51% of patients. Only 36% of patients were scheduled as first case of session which possibly lead to prolonged fasting time. DKI infusion were prescribed in 56% of patients who were on regular insulin or expected prolonged fasting. Point-of-care testing of random glucose was checked in 95% of DM patients on call to operating theatre. Intraoperative glucose was rarely measured. Post-operatively, 83% of patients had reasonably normal serum glucose level and 78% of patients resumed diet within the next two meals. The above figures were all less satisfactory when compared to the practices in UK. We had far less DM patients being seen in preoperative assessment clinic before operations. Therefore, our patients might have less time to be optimized and educated. Our fasting time management was also suboptimal while we had a significantly higher proportion of DM patients being fasted unnecessarily for a longer period of time. Major weaknesses in local practice included the lack of standardized protocols and staff awareness, inflexible fasting time and failure to adjust diabetic medications appropriately during the peri-operative period. Staff education and revision of practices would be urgently needed.
