Presurgical Diabetes Screening Program

A new presurgical diabetes screening and management program is designed to reduce perioperative bleeding and healing complications in patients undergoing spinal procedures.

Initiated by the Department of Anesthesiology at Duke Health, the collaboration involves anesthesiologists, surgeons, endocrinologists, and internists. It has a single goal: Improve glucose control prior to spinal surgery to improve patient outcomes. Screening began last April.

“These patients typically have hardware placed inside their bodies that may increase the risk of infections,” says Erin Manning, MD, an anesthesiologist involved in the initiative. “Combine that with poor glucose control and they don’t always heal well.”

The process of identifying and managing glucose risks in patients undergoing surgery is a carefully charted workflow that requires confirming diabetes and glycated hemoglobin (HbA1c) levels when patients become candidates for spinal procedures. When HbA1c levels exceed 7.5% based on a blood sample taken within the past 3 months, the patient is referred to a preoperative diabetes clinic.

“In the past, there was less attention paid to glycemic control during hospitalizations or in the perioperative period,” says Tracy Steji, MD, medical director for Duke Health’s inpatient endocrine consultation service. “But over time, we’ve seen the associations of poor glycemic control and less optimal outcomes.”

Susan Spratt, MD, Duke Health’s director of diabetes services, describes the multidisciplinary screening effort as “an endocrinologist’s dream.” Spratt created the order set used by providers and nursing staff to initiate glucose control measures and refer patients to Duke Health’s endocrinology clinic.

“Oftentimes we are called in after surgery, when patients’ blood sugars are too high to be discharged and more monitoring is required,” says Spratt. “Or, worst case, they are discharged and come back with an infection.

“But we are thrilled that this initiative allows us to be more proactive,” she adds. “We see patients heal more quickly with lower infection rates and spend less time in the hospital.”

The Duke Spine Center manages approximately 1,200 spine cases each year. Many patients are older and present more risk factors, says Sergio Mendoza-Lattes, MD, a spine surgeon.

“It’s crucially important that our patients are well prepared for the stress of surgery,” Mendoza-Lattes notes. “This program is a way of getting patients safely through the experience with a good outcome.”

Nearly 40 health care professionals collaborated for 10 months to plan and create common work processes for the project they call the Preoperative Diabetes Management Program. Modeled after an anemia management program developed in 2014, the initiative reflects efforts by Duke Anesthesiology’s Perioperative Enhancement Team (POET) to enhance its role in perioperative medicine.

“Duke Anesthesia can now be more directly and proactively involved in the upstream identification of patients who would otherwise be high risk,” says Sol Aronson, MD, anesthesiologist and medical director of POET. “These changes allow us to manage modifiable risk factors so they no longer pose a threat to an adverse outcome downstream.”

Stacey Hilton, communications director for the Department of Anesthesiology, contributed to this article.