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Study questions the relevance of SCIP benchmarks among CABG patients
Date:11/9/2012

(Boston) Cardiothoracic surgeons and endocrinologists from Boston Medical Center (BMC) have found that among patients undergoing coronary artery bypass graft (CABG) surgery, achieving Surgical Care Improvement Project (SCIP) benchmarks for glycemic control may be irrelevant when perioperative continuous insulin infusion protocols are implemented. These findings appear on-line in the Journal of Thoracic and Cardiovascular Surgery.

Currently, 40 percent of all patients undergoing CABG suffer from diabetes, and this number is quickly rising. Traditionally these patients have more complications following surgery, including greater risk of heart attacks, more wound infections and reduced long-term survival. Previous studies from BMC have shown that patients receiving insulin infusions during surgery and in the postoperative period to achieve blood glucose levels of less than 200mg/dl have significantly less morbidity and mortality. As a result of these pioneering studies, national guidelines now mandate that all CABG patients receive an intravenous insulin infusion when necessary to maintain blood glucose levels of less than 200mg/dl in the perioperative period.

SCIP has benchmarked 6 a.m. blood glucose of less than 200 mg/dl on post-operative day one and day two as a quality measure of glycemic control in cardiac surgery to be used for reporting of operative outcomes and monetary reimbursement. However, the relevance of SCIP in patients already receiving continuous insulin infusions, designed to achieve optimal glycemic control, is unknown. Hospitals in which SCIP outliers are present may be publicly cited for poor glycemic control and receive less monetary reimbursement. It is important, therefore, to determine whether SCIP is a valid marker of glycemic control in CABG patients.

Between January 2006 and April 2011, 833 patients underwent CABG surgery at BMC and received continuous insulin infusions to maintain serum blood glucos
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Contact: Gina DiGravio
gina.digravio@bmc.org
617-638-8480
Boston University Medical Center
Source:Eurekalert

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