Peri-operative Management Of The Surgical Patients

Background The prevalence of diabetes in China is rapidly upward to 11.6%, and nearly 25% of diabetic patients in their lives need to undergo a variety of surgical procedures. Many studies have shown that perioperative poor glycemic control can increase the incidence of postoperative myocardial infarction, stroke and wound infection. The effective management of perioperative blood glucose can distinctly improve the incidence of postoperative complications. At present, the numbers of guidelines or consensus on perioperative management of blood glucose are low and most of the quality of the guidelinesare not high.ObjectiveTo develop a high-quality clinical practice guideline of perioperative management of blood glucose in China which can standardize the optimal perioperative blood glucose control goals and glycemic monitoring.Methods The main research methods were as follows: 1) Questionnaire survey; to investigate the current status and urgent problems of perioperative management of blood glucose from surgeons and endocrinologists; 2) Retrospective study: 5 years of surgical perioperative blood glucose control statistical analysis; 3) Literature search and evaluation: searching the literature aboutguideline relatedissues and application of GRADE method toclassify the qualityof evidence and intensity of recommend; 4)Delphi method: toprompt experts reach a consensus on the guideline.Results 1) A questionnaire survey was conducted in 330 surgeons and endocrinologists. The survey showed that surgeons and endocrinologists had particularly different awareness of blood glucose control goals and blood glucose monitoringon perioperative management; more than 50% of the surgeonsbelieved that there was lack of standardized perioperative management of blood glucose control in clinical practices and 11.8% of them considered that they were lack of knowledge of the hypoglycemic drug regimen. 2) A retrospective study was conducted 761 diabetic inpatients in orthopedic. The study showed thatthe congnitive of surgeons about perioperative management of blood glucose control were not tally with clinical reality;there were defects of surgeons’ clinical practice on perioperative management of blood glucose control; diabetes-related risk factors assessment, the timing of surgery for diabetes patients,blood glucose control goals, blood glucose monitoring frequency or the style of anesthesia were controversial. 3) We determined 9 guideline relatedissues, and there were 59 articles to support the guideline, including 40(16.8%)articleswere published between 2011 to 2016,16 (27.1%) guidelines, 15 (25.4%)evidence-based systematic reviews, and 6(10.2%) randomized controlled trials.Combined with evidence-based evidences and advices of guidelinepanel, we formulated the clinical practice guideline for perioperative management of blood glucose control (trial version), including 16 recommendations, B-level evidence accounted for 24.3%, strong recommendation accounted for 27%.Conclusion We used GRADE classification as evidence-based basis, combined with the views of three rounds of Delphi experts, and finally formulated theclinical practice guideline for perioperative management of blood glucose control (trial version),covering five areas: management and coordination in clinical staff, endocrinologists consultation, diabetes diagnosis, timing of surgery and style of anesthesia, and blood glucose target and monitoring frequency. At the same time according to the recommendations, we regulated the blood glucose management process and provide a direct, specific guidance for surgeons in perioperative period.