Outpatient Surgery Magazine

Post Your Prices Online - September 2013 - Outpatient Surgery Magazine - Subscribe

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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OSE_1309_part3_Layout 1 9/6/13 12:21 PM Page 143 INFECTION PREVENTION you also might increase others. It's easy to say that patients with poor glucose control simply shouldn't have elective surgery, but unfortunately, some patients are unlikely to ever achieve great control. In some cases, the reason for surgery — for example, infection or inflammation — is contributing to the poor glucose control. So postponing surgery probably won't provide a significant short-term net benefit. All of which begs the question: What's the best way to deal with the propensity of diabetic patients to develop surgical site infections? Control glucose with caution Use the pre-operative assessment as an opportunity to optimize glucose control. Tight glucose control is a noble goal — but only if you're also adequately monitoring to detect and treat hypoglycemia. Ultimately, you need to balance how much control you can safely achieve. It may be safer and more practical to accept "loose" control of hyperglycemia, as the benefits of tighter control may not warrant what it takes to avoid the dangers of hypoglycemia. 1 Set realistic goals A pre-operative hemoglobin A1C of less than 7.5 and a glucose level less than 120 mg/dl are practical goals for most facilities. How far can you stray from those goals? It depends. The textbook answer is that no surgery should be performed if hemoglobin A1C is greater than 10 or blood glucose is greater than 250. But we all know patients who live quite asymptomatically at much higher levels, and postponing surgery is not without risk, let alone inconvenience. It comes down to a case-by-case determination. A skin graft warrants more rigid standards for postponement than laparoscopy. 2 S E P T E M B E R 2013 | O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E 1 4 3

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