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

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.

Keywords: amélioration de la qualité; durée du séjour; hyperglycémie postopératoire; length of stay; perioperative glycemic management; postoperative hyperglycemia; prise en charge périopératoire de la glycémie; quality improvement.