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

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 mea-sures 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. (c) 2022 Canadian Diabetes Association.

Automated summary

We evaluated the implementation and clinical outcomes of a perioperative glycemic management pathway in gynecologic oncology. The postimplementation period showed an increase in preoperative screening with glycated hemoglobin and blood glucose measurement after surgery for diabetic patients. However, there was no improvement in the proportion of patients with hyperglycemia, and major quality gaps in perioperative glycemic management still existed despite the implementation of a multidisciplinary care pathway. Optimal strategies for improvement in perioperative glycemic management are still unknown.