Surgical Universal euGlycemic Attainment during Recovery (SUGAR) Initiative

Abstract only 252 Background: Surgical site infections (SSI) are infections of the surgical incision or organ space within 30 days of surgery and are associated with increased morbidity, mortality and healthcare expenditures. Diabetic patients undergoing laparotomy are at high risk. Prior studies ha...

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Published in:	Journal of clinical oncology Vol. 36; no. 30_suppl; p. 252
Main Authors:	Taylor, Jolyn Sharpe, Cain, Katherine, Earles, Terri, Harris, Melinda, James, Deepthi, Hubbs, Cheryl, Dottino, Joseph, Stewart, Katherine Ikard, McGrew, Leon, Siebel, Christine, Enbaya, Ahmed, Iniesta, Maria, Vachhani, Shital, Lasala, Javier, Thosani, Sonali, Best, Conor, Sahai, Sunil Kumar, Schmeler, Kathleen M., Ramirez, Pedro T, Meyer, Larissa
Format:	Journal Article
Language:	English
Published:	20-10-2018
Online Access:	Get full text
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Summary:	Abstract only 252 Background: Surgical site infections (SSI) are infections of the surgical incision or organ space within 30 days of surgery and are associated with increased morbidity, mortality and healthcare expenditures. Diabetic patients undergoing laparotomy are at high risk. Prior studies have shown SSI reduction by avoiding hyperglycemia. The aim of our Quality Improvement (QI) initiative is to reduce the SSI rate among diabetic patients undergoing laparotomy by 40% within 2 years compared to the baseline (2/2015-8/2017) rate of 16%. Methods: We formed a multi-disciplinary QI team including physicians, nurses and advanced care providers from Gynecologic Oncology, Pharmacy, Nutrition, Endocrinology, Internal Medicine and Anesthesiology. The intervention began 2/2018 in our main center and 5 satellite sites including: screening gynecologic cancer patients undergoing laparotomy with hemoglobin A1C, intra-operative glucose monitoring with goal of < 180mg/dL, creation and use of a standardized basal-bolus insulin order set for post-operative care, and endocrine and nutritional consultation. The following variables were assessed: age, race, ethnicity, BMI, cancer type, comorbidities, smoking status, surgical procedure, receipt of antibiotic prophylaxis, hemoglobin A1C, post-operative glucose values, intervention compliance, intra-operative complications, post-operative complications including SSI, hospital readmissions, reoperation and mortality. Results: Since 2/2018, 39 gynecologic cancer patients have undergone laparotomy. Overall compliance with HgA1c screening is 64% (25/39), which has improved from 42% in 2/2018 to 70% in 3/2018 and 83% in 4/2018. Causes of non-compliance included unplanned conversion to laparotomy and need for additional education. Five of 39 (13%) patients were diabetic, including one newly diagnosed through this initiative. The post-intervention diabetic SSI rate is 0% (0/5) with all post-intervention glucose values < 180mg/dL. There have been no safety adverse events resulting in patient harm. Conclusions: Implementing a QI initiative to standardize management of diabetic patients undergoing surgery is both safe and feasible. Effectiveness data will continue to be collected.
ISSN:	0732-183X 1527-7755
DOI:	10.1200/JCO.2018.36.30_suppl.252