Intraoperative glycemic protocol calculator: automation in the OR

Document Type

Article

Publication Date

12-1-2025

Publication Title

Journal of clinical monitoring and computing

Keywords

Humans, Retrospective Studies, Male, Female, Blood Glucose, Middle Aged, Aged, Hyperglycemia, Insulin, Automation, Coronary Artery Bypass, Monitoring, Intraoperative, Hypoglycemia, Decision Support Systems, Clinical, Glycemic Control, Operating Rooms, Cardiopulmonary Bypass, Cardiac Surgical Procedures, Intraoperative Care, Guideline Adherence

Abstract

To evaluate whether a web-based Intraoperative Glycemic Protocol Calculator (IGPC) improves provider compliance with intraoperative glycemic management protocols during cardiac surgery. Single-center retrospective cohort study conducted between August - October 2022 (pre-intervention) and April - June 2023 (post-intervention). Tertiary care academic hospital. Adult patients undergoing coronary artery bypass grafting and/or valve surgery requiring cardiopulmonary bypass. Implementation of the IGPC, a web-based clinical decision support tool designed to automate insulin dosing recommendations intraoperatively. Protocol adherence, defined as appropriate insulin administration within five minutes of glucose measurement, was compared before and after IGPC implementation. Among 143 patients, IGPC use significantly increased adherence across all intraoperative phases: Pre-CPB (65.5% to 80.2%, p = 0.017), On-CPB (53.0% to 75.1%, p <  0.001), and Post-CPB (34.8% to 58.8%, p <  0.001). Rates of severe hypoglycemia remained low and unchanged (0.1% in both groups; p = 0.772), and intraoperative hyperglycemia rates were similar (4.2% vs. 4.1%; p = 0.995). Implementation of the IGPC significantly improved real-time adherence to intraoperative glycemic control protocols without increasing adverse glycemic events. However, rates of intraoperative hyperglycemia and hypoglycemia remained unchanged between the pre- and post-intervention phases. These findings highlight the utility of clinical decision support tools in enhancing protocol compliance during high-acuity cardiac surgeries.

Medical Subject Headings

Humans; Retrospective Studies; Male; Female; Blood Glucose; Middle Aged; Aged; Hyperglycemia; Insulin; Automation; Coronary Artery Bypass; Monitoring, Intraoperative; Hypoglycemia; Decision Support Systems, Clinical; Glycemic Control; Operating Rooms; Cardiopulmonary Bypass; Cardiac Surgical Procedures; Intraoperative Care; Guideline Adherence

PubMed ID

41264180

ePublication

ePub ahead of print

Volume

39

Issue

6

First Page

1301

Last Page

1307

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