Endocrinologists may improve surgical care in diabetic patients

by Kristina Fiore

Shorter hospital stays and lower costs were the result when surgical patients with diabetes and dysglycemia received endocrinology consults, researchers said.

Adding endocrinologists to surgical care teams for patients with abnormal blood glucose readings cut total length of stay among patients in a single center by 1,342 days and saved the hospital $1.15 million, according to Arthur Chernoff, MD, of Albert Einstein Medical Center in Philadelphia.

Chernoff presented his findings at the American Association of Clinical Endocrinology meeting.

“The active involvement of the endocrinologist with the surgical team helped decrease the patients’ length of stay and reduced hospital expenses,” he said. “Overall, it pays economically for the hospital, and very well for patients in terms of improved quality of care.”

Chernoff said it has been unclear whether these consults provide a net benefit outside of the intensive care unit (ICU).

Consequently, the researchers conducted a retrospective case-control study at their hospital.

They had previously assessed whether aggressive management of diabetes in cardiac and transplant surgical patients shortened length of stay –- which it did –- and the idea of the current study was to see whether that would extend to general surgery patients as well.

They compared cases in fiscal year 2008 –- in which endocrine consults were not routine –- with cases in fiscal year 2009 when an intervention was initiated.

Under the program, an endocrinologist or diabetes educator provided advice on blood sugar management as soon as abnormal blood sugars were detected, rather than waiting for the surgical team to ask for assistance.

Patient glucose levels were consistently monitored, and the intervention was initiated when those levels fell below 50 mg/dL or rose above 200 mg/dL.

Patients in fiscal 2008 had limited endocrine intervention. At that point, physicians and caregivers followed protocols for the management of hyperglycemia in the ICU and hypoglycemia in all units, with endocrine consultations requested at the discretion of the surgical team.

The researchers found that mean length of stay and cost were significantly lower in 2009 after the intervention started.

In 2008, mean length of stay for those with diabetes was 5.8 days and costs averaged $9,301. For those with hypo- or hyperglycemia, average stay was 4.4 days and costs totaled $7,548.

But in 2009, average length of stay for the diabetic patient was 5.0 days, totaling $8,009. Dysglycemic patients had an average stay of 4.1 days at a cost of $7,440.

Cost differences for those without diabetes weren’t statistically significant, but they were among diabetics (P=0.043).

Length of stay was significantly different at P=0.027 and P=0.037, for those with and without diabetes, respectively.

In 2009, there was also a trend toward more patients being released home, rather than to other institutions, but it was not significant. A trend toward improved mortality wasn’t significant, either.

Chernoff said that for all patients taken together, the total savings in length of stay and costs was 1,342 days and $1.15 million -– with 656 days and $1.06 million of that improvement attributable to the better outcomes for diabetic patients.

He added that the bottom line is “simple,” in that it’s important to address blood sugar control among diabetics undergoing surgery: “This is where endocrinologists need to lead the charge.”

Kristina Fiore is a MedPage Today staff writer.

Originally published in MedPage Today. Visit MedPageToday.com for more endocrinology news.


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