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

• Published in: Gynecologic oncology Vol. 146; no. 2; pp. 228 - 233
• Main Authors: Hopkins, Laura, Brown-Broderick, Jennifer, Hearn, James, Malcolm, Janine, Chan, James, Hicks-Boucher, Wendy, De Sousa, Filomena, Walker, Mark C., Gagné, Sylvain
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017
• Subjects: Aged; Case-Control Studies; Diabetes; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - therapy; Female; Genital Neoplasms, Female - surgery; Glycated Hemoglobin A - metabolism; Gynecologic cancer; Gynecologic Surgical Procedures; HbA1C; Humans; Hyperglycemia; Hyperglycemia - drug therapy; Mass Screening; Middle Aged; Postoperative Complications - drug therapy; Prediabetic State - diagnosis; Prediabetic State - metabolism; Prediabetic State - therapy; Referral and Consultation; Retrospective Studies; Risk Assessment; Surgical site infection; Surgical Wound Infection - prevention & control; Surgical site infection; Hyperglycemia; Diabetes; HbA1C; Gynecologic cancer
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2017.05.021

•Surgical site Infections are a common, costly complication of surgery.•Screening for HbA1C predicts patients likely to suffer post-operative hyperglycemia.•Interventions maintaining perioperative normoglycemic lowers risk of surgical site infections.•Screening for HbA1C diagnoses previously unaware diabetes/pre-diabetes patients. To evaluate the frequency of surgical site infections before and after implementation of a comprehensive, multidisciplinary perioperative glycemic control initiative. 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 ≤10mmol/L (180mg/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. 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, 60.0years; p=0.422) and BMI (avg. 31.1, 32.3kg/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. 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.