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Implementation of a referral to discharge glycemic control initiative for reduction of surgical site infections in gynecologic oncology patients

2017; Elsevier BV; Volume: 146; Issue: 2 Linguagem: Inglês

10.1016/j.ygyno.2017.05.021

1095-6859

Laura Hopkins, J. Brown‐Broderick, James C. Hearn, Janine Malcolm, James Chan, Wendy Hicks-Boucher, Filomena De Sousa, Mark Walker, Sylvain Gagné,

Surgical site infection prevention

Objective(s) To evaluate the frequency of surgical site infections before and after implementation of a comprehensive, multidisciplinary perioperative glycemic control initiative. Study methods As part of a CUSP (Comprehensive Unit-based Safety Program) initiative, between January 5 and December 18, 2015, we implemented comprehensive, multidisciplinary glycemic control initiative to reduce SSI rates in patients undergoing major pelvic surgery for a gynecologic malignancy ('Group II'). Key components of this quality of care initiative included pre-operative HbA1c measurement with special triage for patients meeting criteria for diabetes or pre-diabetes, standardization of available intraoperative insulin choices, rigorous pre-op/intra-op/post-op glucose monitoring with control targets set to maintain BG ≤10 mmol/L (180 mg/dL) and communication/notification with primary care providers. Effectiveness was evaluated against a similar control group of patients ('Group I') undergoing surgery in 2014 prior to implementation of this initiative. Results We studied a total of 462 patients. Subjects in the screened (Group II) and comparison (Group I) groups were of similar age (avg. 61.0, 60.0 years; p = 0.422) and BMI (avg. 31.1, 32.3 kg/m2; p = 0.257). Descriptive statistics served to compare surgical site infection (SSI) rates and other characteristics across groups. Women undergoing surgery prior to implementation of this algorithm (n = 165) had an infection rate of 14.6%. Group II (n = 297) showed an over 2-fold reduction in SSI compared to Group I [5.7%; p = 0.001, adjRR: 0.45, 95% CI: (0.25, 0.81)]. Additionally, approximately 19% of Group II patients were newly diagnosed with either prediabetes (HbA1C 6.0–6.4) or diabetes (HbA1C ≥ 6.5) and were referred to family or internal medicine for appropriate management. Conclusion(s) Implementation of a comprehensive multidisciplinary glycemic control initiative can lead to a significant reduction in surgical site infections in addition to early identification of an important health condition in the gynecologic oncology patient population.