Improving Perioperative Glycaemic Management in Vascular Surgery Inpatients: A Two-Cycle Quality Improvement Project

Introduction:

Diabetes and poor glycaemic control are major risk factors for peripheral arterial disease, lower limb ulceration and critical limb threatening ischaemia (CLTI).(1) Poor glycaemic control is linked with worse postoperative outcomes and increased mortality.(2) This two-cycle quality improvement project evaluated perioperative glycaemic management and escalation in vascular surgery inpatients.

Aim: 

To assess compliance with trust guidelines for vascular surgery inpatient diabetes management and evaluate the impact of newly implemented guidelines and staff teaching on glycaemic control and escalation practices.  

Methods:

A retrospective two-cycle quality improvement project was conducted at a tertiary vascular centre over two four-week periods. Adult inpatients undergoing vascular surgery with presenting complaints of CLTI, diabetic foot infection (DFI) and abdominal aortic aneurysm were included. Data collected included demographics, diabetes status, perioperative capillary blood glucose (CBGs) levels, presence of ketosis and escalation to diabetes teams. Cycle 1 and Cycle 2 outcomes were compared following implementation of new trust guidelines, communicated via a poster outlining hyperglycaemia and hypoglycaemia treatment algorithms and clear escalation pathways.

Results:

Diabetes prevalence remained stable across the cycles but the proportion of diabetic patients with uncontrolled perioperative CBGs increased from 51.1% to 61.7%. CLTI and DFI remained the predominant presentation associated with uncontrolled CBGs. Escalation to diabetes teams improved from 47.8% to 57.1%. Ketosis rates reduced from 11.5% to 5.0%, with escalation improving from 66.0% to 100%. Overall, escalation practices improved following new guideline implementation  

Conclusion:

Uncontrolled CBGs remain prevalent among vascular surgery inpatients particularly those presenting with CLTI or DFI. Introduction of new trust guidelines and targeted teaching sessions demonstrated a measurable improvement in escalation practices, most notably patients experiencing ketosis - 100% of patients were appropriately escalated. Continued emphasis of early identification, consistent use of glycaemic protocols and clear referral pathways is essential to further optimise inpatient diabetes management and surgical outcomes.