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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
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      Abstract

      Objective

      We evaluated implementation and clinical outcomes of a perioperative glycemic management pathway (PGMP) in gynecologic oncology.

      Methods

      Interrupted times series analysis was used to compare process, balancing, and outcome measures and clinical outcomes from 18-months pre-implementation to 18-months post-implementation.

      Results

      Compared to the pre-implementation period, the proportion of patients who underwent preoperative screening with hemoglobin A1c increased by 11.3% (95%CI: 5.0-17.7%; p=0.001). The proportion of patients with diabetes who had at least one blood glucose measurement after surgery increased by 15.3% (95%CI: -3.2-33.8%; p=0.10). There was no change in the proportion of patients who had any hyperglycemia, moderate or severe hyperglycemia. The median length of stay decreased by 0.42 days (95%CI: -0.91-0.07 days; p=0.09).

      Discussion

      There were important 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.

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