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Surgical Care Improvement Project measure for postoperative glucose control should not be used as a measure of quality after cardiac surgery

  • Damien J. LaPar
    Affiliations
    Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va
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  • James M. Isbell
    Affiliations
    Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va
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  • John A. Kern
    Affiliations
    Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va
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  • Gorav Ailawadi
    Affiliations
    Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va
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  • Irving L. Kron
    Correspondence
    Address for reprints: Irving L. Kron, MD, Virginia Interdisciplinary Cardiothoracic Outcomes Research Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, PO Box 800679, Charlottesville, VA 22908.
    Affiliations
    Virginia Interdisciplinary CardioThoracic Outcomes Research (VICTOR) Center, Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Va
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Published:January 13, 2014DOI:https://doi.org/10.1016/j.jtcvs.2013.11.028

      Objective

      The current Surgical Care Improvement Project (SCIP) measure for controlled postoperative 6-am glycemic control after cardiac surgery identifies those with blood glucose levels of ≤200 mg/dL. The purpose of the present study was to evaluate the effect of achieving this SCIP measure on risk-adjusted postoperative cardiac surgical outcomes.

      Methods

      The data were analyzed for all cardiac surgery patients from a single institution (June 2010 to August 2012). The patients were categorized by the postoperative 6-am glucose levels into 2 SCIP measure cohorts: SCIP (≤200 mg/dL) versus non-SCIP (>200 mg/dL). Propensity-matched cohort comparisons and multiple regression analyses assessed the associations between SCIP measure compliance and the risk-adjusted outcomes.

      Results

      Of 1703 patients, 1527 (90%) achieved SCIP measure glycemic control. Preoperative diabetes was more common among the non-SCIP patients (P < .001); the median Society of Thoracic Surgeons-predicted mortality (P = .14) was similar between the 2 groups. No significant differences were observed in major morbidity, mortality, or resource usage among the propensity-matched cohorts. After adjustment for Society of Thoracic Surgeons-predicted risk, non-SCIP status was not associated with increased mortality (P = .44), composite major morbidity (P = .16), major sternal complications (P = .68), total intensive care unit duration (P = .70), or postoperative length of stay (P = .27). Similar risk-adjusted results were estimated for patients undergoing isolated coronary artery bypass grafting.

      Conclusions

      Achieving the SCIP measure for controlled postoperative 6-am blood glucose levels ≤200 mg/dL after cardiac surgery was not associated with improved risk-adjusted mortality, morbidity, or hospital resource usage. These data suggest that this metric might not be a valid measure of postoperative cardiac surgical quality.

      CTSNet classification

      Abbreviations and Acronyms:

      BG (blood glucose), CABG (coronary artery bypass grafting), ICU (intensive care unit), POD (postoperative day), SCIP (Surgical Care Improvement Project), STS (Society of Thoracic Surgeons)
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