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Measure Information Form
Version 2010B


**NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE**

Measure Information Form

Measure Set: Surgical Care Improvement Project (SCIP)

Set Measure ID: SCIP-Inf-4

Performance Measure Name: Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Blood Glucose

Description: Cardiac surgery patients with controlled 6 A.M. blood glucose (≤ 200 mg/dL) on postoperative day one (POD 1) and postoperative day two (POD 2) with Surgery End Date being postoperative day zero (POD 0).

Rationale: Hyperglycemia has been associated with increased in-hospital morbidity and mortality for multiple medical and surgical conditions. In a study by Zerr, et al (1997), the risk of infection was significantly higher for patients undergoing coronary artery bypass graft (CABG) if blood glucose levels were elevated. Furthermore, Zerr, et al (2001), demonstrated that the incidence of deep wound infections in diabetic patients undergoing cardiac surgery was reduced by controlling mean blood glucose levels below 200mg/dL in the immediate postoperative period. Latham, et al (2001), found that hyperglycemia in the immediate postoperative phase increases the risk of infection in both diabetic and nondiabetic patients and the higher the level of hyperglycemia, the higher the potential for infection in both patient populations. A study conducted in Leuven, Belgium (Van den Berghe, 2001), demonstrated that intensive insulin therapy not only reduced overall in-hospital mortality but also decreased blood stream infections, acute renal failure, red cell transfusions, ventilator support, and intensive care. Hyperglycemia is a risk factor that, once identified, could minimize adverse outcomes for cardiac surgical patients.

Type of Measure: Process

Improvement Noted As: Increase in the rate

Numerator Statement: Surgery patients with controlled 6 A.M. blood glucose (≤ 200 mg/dL) on POD 1 and POD 2.
Included Populations: Not applicable

Excluded Populations: None

Data Elements:

Denominator Statement: Cardiac surgery patients with no evidence of prior infection.

Included Populations:
  • An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.10 for ICD-9-CM codes)
    AND
  • An ICD-9-CM Principal Procedure Code of selected surgeries (as defined in Appendix A, Table 5.11 for ICD-9-CM codes)

Excluded Populations:

  • Patients less than 18 years of age
  • Patients who have a length of Stay >120 days
  • Patients who had a principal diagnosis suggestive of preoperative infectious diseases (as defined in Appendix A, Table 5.09 for ICD-9-CM codes)
  • Burn and transplant patients (as defined in Appendix A, Tables 5.14 and 5.15 for ICD-9-CM codes)
  • Patients whose ICD-9-CM principal procedure was performed entirely by laparoscope
  • Patients enrolled in clinical trials
  • Patients whose ICD-9-CM principal procedure occurred prior to the date of admission
  • Patients with physician/advanced practice nurse/physician assistant (physician/APN/PA) documented infection prior to surgical procedure of interest
  • Patients who expired perioperatively

Data Elements:

Risk Adjustment: No.

Data Collection Approach: Retrospective data sources for required data elements include administrative data and medical records. Retrospective data sources for required data elements include administrative data and medical records.

Data Accuracy: Variation may exist in the assignment of ICD-9-CM codes; therefore, coding practices may require evaluation to ensure consistency.

Measure Analysis Suggestions: It is important that blood glucose levels be maintained and documented throughout the entire postoperative period. In the course of quality improvement efforts, hospitals may find it useful to drill down to the responses for the data elements Glucose POD1 and Glucose POD2. Further insight may be gained by examining the consistency and values of blood glucose diagnostics and documentation within the organization.

Sampling: Yes. For additional information see the Sampling Section.

Data Reported As: Aggregate rate generated from count data reported as a proportion.

Selected References:

  • Gordon SM, Serkey JM, Barr C, et al. The relationship between glycosylated hemoglobin (HgA1c) levels and postoperative infections in patients undergoing primary coronary artery bypass surgery (CABG.) Infect Control Hosp Epidemiol. 1997;18(No.5, Part 2):29(58.) PMID: 00000.
  • Furnary AP, Zerr KJ, Grunkemeier GL, et al. Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann Thorac Surg. 1999:67:352-360. PMID: 10197653.
  • Golden SH, Peart-Vigilance C, Kao WH, et al. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care. 1999 Sep;22(9):1408-1414. PMID: 10480501.
  • Trick WE, Scheckler WE, Tokars JI, et al. Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2000 Jan;119(1):108-114. PMID: 10612768.
  • Trick WE, Scheckler WE, Tokars JI, et al. Risk factors for radial artery harvest site infection following coronary artery bypass graft surgery. Clin Infect Dis. 2000 Feb;30(2):270-275.PMID: 10671327.
  • Menzin J, Langly-Hawthron C, Friedman M, et al. Potential short-term economic benefits of improved glycemic control: a managed care prospective. Diabetes Care. 2001 Jan;24(1):51-55. PMID: 11194241.
  • Dellinger E. Preventing Surgical-Site Infections: The importance of timing and glucose control. Infect Control Hosp Epidemiol. 2001;22(10):604-606. PMID: 11776344.
  • Latham R, Lancaster AD, Covington JF, etal. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery patients. Infect Control Hosp Epidemiol. 2001 Oct;22(10):607-612. PMID: 11776345.
  • McAlister FA, Man J, Bistritz L, et al. Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes. Diabetes Care. 2003 May;26(5):1518-1524. PMID: 12716815.
  • Estrada CA, Young JA, Nifong LW, et al. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg. 2003 May;75(5):1392-1399. PMID: 12735552.
  • Terranova A. The effects of diabetes mellitus on wound healing. Plast Surg Nurs. 1991:11(1):20-25. PMID: 2034714.
  • Woodruff RE, Lewis SB, McLeskey CH, et al. Avoidance of surgical hyperglycemia in diabetic patients. JAMA. 1980 Jul 1;244(2):166-168. PMID: 6991732.
  • Dellinger EP, Gross PA, Barrett TL, et al: Quality standard for antimicrobial prophylaxis in surgical procedures. Infectious Diseases Society of America. Clin Infect Dis. 1994;18: 422-427. PMID: 8207176.
  • Zerr KJ, Furnary AP, Grunkemeier GL, et al. Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997 Feb;63(2):356-361. PMID: 9033300.
  • Pomposelli JJ, Baxter JK 3rd, Babineau TJ, et al. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. J Parenter Enteral Nutr. 1998 Mar-Apr;22(2):77-81. PMID: 9527963.
  • Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001 Nov 8;345(19):1359-1367. PMID: 11794168.

Measure Algorithm:

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Measure Information Form SCIP-Inf-4
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)
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