Gallstone Surgery: If Blood Glucose Cannot Be Controlled, Can the Outcome Not Be Controlled Either? The Hospital-Wide Blood Glucose Management Provides the Answer

Cholelithiasis (also known as "gallstones") is a common condition in general surgery, closely associated with dietary structure, metabolic status, obesity, and hepatobiliary function. Clinically, it is not difficult to observe that patients with metabolic disorders, particularly those with type 2 diabetes mellitus (T2DM), often exhibit gallbladder motility disturbances and altered bile composition, making them more prone to gallstone formation. Additionally, diabetes-related immune dysfunction, delayed tissue repair, and perioperative blood glucose fluctuations may increase the risk of postoperative complications and delay recovery.

However, in non-endocrinology wards, blood glucose management often faces challenges such as "non-standardized monitoring, insufficient individualized protocols, and delayed consultations." Against this background, the "hospital-wide blood glucose management" model, led by the endocrinology department, has emerged to achieve standardized in-hospital blood glucose management through institutionalized and informatized approaches. But can it truly resolve the blood glucose management dilemma in the surgical department? Can it effectively improve patient outcomes?

A retrospective cohort study provides a clear answer......

Research Design: Applying "Hospital-Wide Blood Glucose Management" to Patients with "Cholelithiasis & T2DM"

• Study Subjects: 90 patients with T2DM complicated by cholelithiasis who were treated in Shanxi Bethune Hospital from September 2022 to October 2023.
• Inclusion Criteria and Exclusion Criteria：

• Grouping Method:
• Hospital-wide Blood Glucose Management Group (45 cases): Managed uniformly by the "Hospital-wide Blood Glucose Management Team" using insulin pumps, daily rounds, diet and exercise guidance, dynamic blood glucose assessment and adjustment, etc.
• Conventional Treatment Group (45 cases): Treated according to the conventional hypoglycemic methods in the surgical ward.
• Main Observation Indicators:
• Indicators related to hospital stay days;
• Postoperative complications;
• Hospitalization costs;
• Quality of blood glucose control [time in range (TIR), average blood glucose];
• Antibiotic usage;
• Postoperative complications;
• Whether re-admission is due to incomplete treatment or recurrence of cholelithiasis.

Key Result:

"Whole-Hospital Blood Glucose Management" is Superior to Conventional Treatment!

• The preoperative blood glucose of the Hospital-wide Blood Glucose Management Group is more stable: TIR is improved, and the average blood glucose is decreased

A higher TIR indicates a safer metabolic state, laying the foundation for surgery and postoperative recovery.

• Reduction in length of hospital stay for the hospital-wide blood glucose management group: the median hospital stay decreased by 2 days

Reducing the length of hospital stay not only improves bed turnover but also directly improve the patient experience.

• The hospital-wide blood glucose management team significantly reduced postoperative complications: 33.3% vs 11.1%

This is because stable blood glucose significantly improves the environment for immunity and tissue healing.

• Reduction in hospitalization expenses of the hospital-wide blood glucose management group: The reduction in drug expenses is particularly significant

The reduction in costs comes not only from reduced medication use, but also from shorter hospital stays and fewer complications.

From "Controlling Blood Glucose" to "Controlling Outcomes Well":

Why is "Hospital-Wide Blood Glucose Management" More Effective?

Based on this study and previous evidence-based findings, the reason why "hospital-wide blood glucose management" can significantly improve perioperative prognosis mainly stems from four key mechanisms:

1. The hospital-wide blood glucose management system achieves visualization, early warning, and traceability of blood glucose data: The system can automatically generate trend charts and promptly alert for abnormalities, effectively preventing missed detection and reporting. This enables healthcare teams to make rapid decisions based on real-time data, thereby enhancing the accuracy and timeliness of blood glucose management.
2. The collaborative model of "Endocrinology Department & Surgery Department & Nursing": The Endocrinology Department is responsible for formulating glucose control strategies, the Surgery Department manages perioperative care, and the nursing team is in charge of implementation and feedback. Through standardized procedures, treatment delays are reduced, making the management more continuous, standardized, and efficient.
3. Insulin pump therapy enables more controllable blood glucose curves: Under the hospital-wide blood glucose management framework, the insulin pump can flexibly adjust the basal rate and bolus dose according to the patient's condition, making blood glucose fluctuations more closely aligned with physiological rhythms. This significantly improves TIR, reduces metabolic stress, and provides a more stable metabolic environment for postoperative healing.
4. Systematized patient education: Covering key aspects such as diet, exercise, and hypoglycemia prevention, to sustain effective glycemic control patterns during hospitalization into the post-discharge period, thereby enhancing overall compliance and long-term management outcomes.

Perioperative hyperglycemia is a significant risk factor affecting postoperative recovery and complication occurrence. Standardized and effective glycemic management has been proven to significantly reduce the risk of postoperative infections. The findings of this study are highly consistent with previous evidence. After implementing hospital-wide glycemic management, the incidence of postoperative infections in patients was markedly decreased, thereby reducing the demand for related treatments such as antibiotics and nutritional support, which effectively lowered overall medication costs.

Overall, the hospital-wide blood glucose management effectively addresses the shortcomings of traditional in-hospital glucose monitoring, such as non-standardized monitoring, insufficient individualization, and frequent hyperglycemia in non-specialty wards. It demonstrates significant advantages in improving perioperative glucose control, reducing complications, shortening hospital stays, and alleviating economic burdens. This management model is worthy of promotion across more disciplines and wards.

Reference：

[1]Chinese Society of Surgery, Chinese Society of Infectious Diseases and Critical Care Medicine, Chinese Medical Doctor Association, Chinese Society of Surgeons, Chinese Society of Surgeons for Intestinal Fistula. Chinese Guidelines for the Prevention of Surgical Site Infection [J]. Chinese Journal of Gastrointestinal Surgery, 2019,22(4):301-314. DOI: 10.3760/cma.j.issn.1671-0274.2019.04.001.

[2] Wang Q, Cao M, Tao H, et al. Evidence-based guideline for the prevention and management of perioperative infection[J]. J Evid Based Med, 2023, 16(1): 50-67. DOI: 10.1111/jebm.12514.