Abstract
Objective
We evaluated implementation and clinical outcomes of a perioperative glycemic management
pathway in gynecologic oncology.
Methods
Interrupted time-series analysis was used to compare process, balancing and outcome
measures and clinical outcomes from 18 months preimplementation to 18 months postimplementation.
Results
Compared with in the preimplementation period, the proportion of patients who underwent
preoperative screening with glycated hemoglobin in the postimplementation period increased
by 11.3% (95% confidence interval [CI], 5.0% to 17.7%; p=0.001). The proportion of
patients with diabetes who had at least 1 blood glucose measurement after surgery
increased by 15.3% (95% CI, −3.2% to 33.8%; p=0.10). There was no change in the proportion
of patients who had any hyperglycemia or moderate or severe hyperglycemia. The median
length of stay decreased by 0.42 days (95% CI, −0.91 to 0.07 days; p=0.09). There
were major quality gaps in perioperative glycemic management that did not clearly
improve after implementation of a multidisciplinary care pathway.
Conclusion
Optimal strategies for improvement of perioperative glycemic management are not yet
known.
Résumé
Objectif
Nous avons évalué la mise en œuvre et les résultats cliniques d’un protocole de prise
en charge périopératoire de la glycémie en oncologie gynécologique.
Méthodes
Nous avons utilisé une analyse des séries chronologiques interrompues pour comparer
les mesures de processus, d’équilibre et de résultats, et les résultats cliniques
de 18 mois avant la mise en œuvre à 18 mois après la mise en œuvre.
Résultats
Comparativement à la période précédant la mise en œuvre, la proportion de patientes
qui subissaient un dépistage préopératoire de l’hémoglobine glyquée augmentait de
11,3 % (intervalle de confiance [IC] à 95 %, de 5,0 % à 17,7 %; p = 0,001). La proportion
de patientes diabétiques qui avaient au moins une mesure de la glycémie après l’intervention
chirurgicale augmentait de 15,3 % (IC à 95 %, de −3,2 % à 33,8 %; p = 0,10). La proportion
de patientes de toute hyperglycémie ou dont l’hyperglycémie était modérée ou sévère
ne changeait pas. La durée médiane du séjour diminuait de 0,42 jour (IC à 95 %, de −0,91
à 0,07 jour; p = 0,09). Il y avait des lacunes importantes dans la qualité de la prise
en charge périopératoire de la glycémie, qui ne s’était nettement pas améliorée après
la mise en œuvre d’un protocole multidisciplinaire de soins.
Conclusion
On ne connaît pas encore de stratégies optimales pour améliorer la prise en charge
périopératoire de la glycémie.
Keywords
Mots clés
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Article info
Publication history
Published online: November 24, 2022
Accepted:
November 22,
2022
Received in revised form:
September 14,
2022
Received:
February 24,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Canadian Diabetes Association.
