Pharmacist Glycemic Control Team Associated With Improved Perioperative Glycemic and Utilization Outcomes

Objectives: Perioperative hyperglycemia is a risk factor for increased surgical morbidity and mortality. Pharmacy-led management teams may improve glycemic control and postoperative outcomes. We sought to determine whether a pharmacist-led glycemic control team is associated with improved glycemic control and reduced postdischarge utilization and medical costs. Study Design: Retrospective, observational study. Methods: We assessed patient-level outcomes during a 12-month pre-intervention period and compared them at years 1 and 2 post implementation at a tertiary care multi-specialty medical center. The patients were noncritically ill postoperative surgical patients followed 72 hours post surgery (days 1-3). Measurements were proportion of patients with good glycemic control (capillary blood glucose [CBG] 70-180 mg/dL) (day 1), hypoglycemia (CBG <70 mg/dL) (days 1-3), 90-day postdischarge utilization, and 6-month per patient per month (PPPM) medical costs. Results: Glycemic control significantly improved in year 1 (odds ratio [OR], 2.24; 95% CI, 1.85-2.72) and year 2 (OR, 2.19; 95% CI, 1.81-2.66) post implementation; hypoglycemia declined significantly in year 1 (OR, 0.38; 95% CI, 0.31-0.46) and year 2 (OR, 0.31; 95% CI, 0.25-0.38). In addition, postdischarge hospital readmissions declined in year 1 (OR, 0.69; 95% CI, 0.56-0.86) and year 2 (OR, 0.67; 95% CI, 0.54-0.84) post implementation, and emergency department utilization declined in year 1 (OR, 0.71; 95% CI, 0.60-0.84) and year 2 (OR, 0.72; 95% CI, 0.60-0.85) post intervention. Finally, PPPM costs declined significantly in year 1 (beta coefficient = -208.8) and year 2 (beta coefficient = -283.5) post implementation. Conclusions: The intervention was associated with improved glycemic control outcomes, reduced utilization, and lowered postdischarge medical costs.