Invited commentary on Vanderhoek S, et al.: Association of dysglycemia with post-operative outcomes in pediatric surgery

Years ago, in the early days of pediatric Enhanced Recovery after Surgery [ERAS] work, I was part of a Delphi process where the key components of a multi-center ERAS protocol were being determined by the opinions of people considered experts in Inflammatory Bowel Disease surgery, and who were trying to become experts in ERAS. [ [1] Short H.L. Taylor N. Piper K. Raval M.V. Appropriateness of a pediatric-specific enhanced recovery protocol using a modified Delphi process and multidisciplinary expert panel. J Pediatr Surg. 2018; 53 (AprEpub 2017 Sep 23.PMID: 29017725): 592-598https://doi.org/10.1016/j.jpedsurg.2017.09.008 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar ] “Managing Blood Glucose” [BG] did not make our list of key components of care. None of us felt that a focus on perioperative BG control in the protocol would influence the complications, as it was having little impact on our practices…. I seem to remember thinking…: “Getting an Endocrinology consult in those few pediatric patients presenting with Type 1 or 2 diabetes who come to surgery will let the us [the surgeons] focus on other parts of the protocol. That should be sufficient…”. In addition, while we were writing definitions for the various terms and reported variables in the beta version of NSQIP-Pediatrics, we spent little time thinking about how to define BG parameters, let alone understanding “dysglycemia”. [ [2] Raval M.V. Dillon P.W. Bruny J.L. et al. American college of surgeons national surgical quality improvement program pediatric: a phase 1 report. J Am Coll Surg. 2011; 212: 1-11 Crossref PubMed Scopus (135) Google Scholar , [3] Bruny J.L. Halll B.L. Barrnhart D.C. et al. American college of surgeons national surgical quality improvement program pediatric: a beta phase report. J Pediatr Surg. 2013; 48 (Jan): 74-80 Abstract Full Text Full Text PDF PubMed Scopus (122) Google Scholar ] It seemed quite reasonable at the time….