Aim: Diabetes is the most common metabolic disorder in the UK, affecting 2030% of vascular inpatients. Diabetes is associated with increased mortality and adverse outcomes. Major vascular operations accompany an increased incidence of metabolic complications. There are trust guidelines outlining the optimal peri-operative management of diabetes. We audited compliance to this guideline in patients undergoing major vascular operations and measured patient outcomes.
Methods: Retrospective data analysis was performed on diabetic patients undergoing major elective vascular operations between July and December 2018. Adherence to the trust guideline was analysed in terms of pre-operative assessment, medication changes, diabetes team referrals, prescription and use of variable rate insulin infusion (VRII). The intervention was departmental teaching in January. The second cycle was undertaken between January and May 2019.
Results: Thirty-five patients made up the first cycle, of which 20(57%) had HBA1C measured and 2(6%) had their diabetes control optimised in the pre-operative clinic. Of the total 35 patients, 4(11%) had inappropriate medications modifications, 7(20%) were inappropriately referred to the diabetes team and VRII was inappropriately initiated or prescribed in 3(9%) of these. The second cycle consisted of 46 patients. Thirty-five (76%) had their HBA1C measured pre-operatively, with 5(11%) of them referred to their general practitioner for diabetes optimisation. Medications were inappropriately modified in 4(9%) of patients, with 4(9%) inappropriate referrals to the diabetes team. VRII was inappropriately prescribed or initiated in 2(4%) of patients.
Conclusion: An improved peri-operative management of diabetes was seen post intervention. There was improved preoperative optimisation of diabetes. Doctors prescribed medications and VRII more appropriately. The rate of inappropriate diabetes referrals was reduced, streamlining diabetes resources. We showed that simple interventions, such as departmental teaching, can increase awareness among teams and lead to improved outcomes. This intervention can be applied to other surgical specialties.