Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Blood Glucose (NQF 0300)

eMeasure Name Cardiac Surgery Patients With Controlled 6 A.M. Postoperative Blood Glucose eMeasure Id A339C2CF-3077-4ED3-B07D-424611FE185B
Version number 1 eMeasure Set Id 1459F33E-5A81-445E-B038-3A4F26F30808
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by National Quality Forum
Description Cardiac surgery patients with controlled 6 A.M. blood glucose (less than or equal to 200 mg/dL) on postoperative day one (POD 1) and postoperative day two (POD 2) with Anesthesia End Date being postoperative day zero (POD 0).
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
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.
Clinical Recommendation Statement
Controlling hyperglycemia can reduce adverse effects after surgery. Studies have shown that hyperglycemia has been associated with increased in-hospital morbidity and mortality for multiple medical and surgical conditions.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
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.
Reference
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.
Reference
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.
Reference
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.
Reference
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.
Reference
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.
Reference
Dellinger E. Preventing Surgical-Site Infections: The importance of timing and glucose control. Infect Control Hosp Epidemiol. 2001;22(10):604-606. PMID: 11776344.
Reference
Latham R, Lancaster AD, Covington JF, etal. The association of diabetes and glucose control with surgical-site infections among cardiothoracic surgery Specifications Manual for National Hospital Inpatient Quality Measures Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11) SCIP-Inf-4-3 patients. Infect Control Hosp Epidemiol. 2001 Oct;22(10):607-612. PMID: 11776345.
Reference
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.
Reference
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.
Reference
Terranova A. The effects of diabetes mellitus on wound healing. Plast Surg Nurs. 1991:11(1):20-25. PMID: 2034714.
Reference
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.
Reference
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.
Reference
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.
Reference
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.
Reference
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.
Definition
Initial Patient Population(s): All hospital discharges for cardiac surgery with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission and no evidence of prior infection 18 years of age and older
Definition
Denominator(s): Cardiac surgery patients with no evidence of prior infection 18 years of age and older with An ICD-9-CM Principal Procedure Code of selected surgeries AND An ICD-9-CM Principal Procedure Code of selected surgeries
Definition
Denominator Exclusion(s): Patients who had a principal diagnosis suggestive of preoperative infectious diseases.
Burn and transplant patients.
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.
Definition
Numerator(s): Surgery patients with controlled 6 A.M. blood glucose (less than or equal to 200 mg/dL) on post-operative day (POD) 1 and postoperative day (POD) 2.
Definition
Denominator Exception(s): N/A
Guidance
The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec.

Patients for whom there are missing or inaccurate data (e.g., arrival time, medication administration, etc.) are considered to have failed the measure; the total number of patients with missing or erroneous (e.g., a time of 03:69 or a date of 10/26/2035) data (i.e., measure failures) must be reported with the results of the measure.

General guidance:

The original measure excludes patients who have had a laparoscopic procedure unless the laparoscopic incision has been extended during the procedure.  ICD-10 allows definition of such extension with procedure codes; ICD-9 does not. For those using ICD-9 any laparoscopic procedure that extends the incision should be included. In this measure the value sets that describe types of surgical procedures remain only in ICD-9 or ICD-10 because the concepts that apply are limited to a very specific subset of all surgical procedures.

Exclusion element guidance:

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for the same conditions as covered by the measure. Other clinical trials are not valid reasons for exclusions. 

The measure as initially specified excludes all patients who die peri-operatively.  The exclusion in this measure covers the same peri-operative scenario, the death time is the same as the discharge time.  AND NOT [Encounter: encounter inpatient].discharge date starts after the end of [Procedure, Performed: Joint Commission Evidence a surgical procedure requiring general or neuraxial anesthesia].end date starts after the end of [Procedure, Performed: cardiac surgery].date < 2 days. 

By convention, discharge date post "encounter inpatient" is used to describe the hospital discharge date.  Where logic needs to indicate discharge (or transfer) from one inpatient location to another, the logic uses "Transfer From" or "Transfer To" as the QDM data type.
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012