Final Scholarly Project: Evidence-based Practice Guidelines for the Perioperative Management of Blood Glucose Levels in the Cardiac Surgery Patient

Cardiovascular disease is the leading cause of mortality worldwide, necessitating a high demand for cardiac surgery. A unique stressor for cardiac surgery is an increased surgical stress response involving hyperglycemia. Perioperative hyperglycemia contributes to adverse postoperative outcomes following cardiac surgery. Current evidence examines blood glucose control and its effect on adverse postoperative outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit. Despite the link between hyperglycemia and poor postoperative outcomes, most facilities lack standardized guidelines for the perioperative management of blood glucose levels in cardiac surgery patients. This project aims to have anesthesia providers implement blood glucose management guidelines in adult cardiac surgery patients during the perioperative setting. The Johns Hopkins Evidence-based Practice model guided the project through initial research, planning, implementation, and dissemination. A literature synthesis and analysis were conducted to synthesize current evidence supporting the development of guidelines to decrease adverse postoperative outcomes after cardiac surgery. The project team educated critical stakeholders, including anesthesia providers, and implemented blood glucose management guidelines based on current evidence. Outcomes following the implementation of the blood glucose guidelines will be compared to pre-implementation outcomes. The project team will analyze the post-implementation outcomes, including sternal wound infections, acute kidney injury, prolonged mechanical ventilation, and an increased length of stay in the intensive care unit, for improvements to assess whether the guidelines can be disseminated, or adjustments are needed.