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Implementation of a Perioperative Glycemic Management Quality Improvement Pathway in Gynecologic Oncology Patients: A Single-cohort Interrupted Time-series Analysis

Published:November 24, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.11.007

      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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