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

Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations—2019 update

“…A recent study among gynecologic oncology patients found that implementing an intensive post-operative glycemic control initiative using a continuous insulin infusion resulted in a 35% reduction in the rate of surgical site infections among patients with diabetes 114. Similarly, authors of another study decreased the surgical site infection rate by 55% through implementation of an initiative standardizing post-operative management of diabetic and pre-diabetic patients using a multidisciplinary team 109. Importantly, glucose management must avoid hypoglycemia as well as hyperglycemia as both extremes have been associated with higher mortality risk 115 116.…”

“…Reduction in surgical site infection is key in patients undergoing pelvic exenteration or HIPEC therapy. Recent studies have shown that implementation of a comprehensive glycemic control initiative can lead to a decrease in surgical site infection from 14.6% to 5.7% 109. In addition, early mobilization intuitively will promote a faster and safer recovery by reducing the risk of thromboembolic events, as well as the risk of pulmonary complications.…”

Prevention of surgical site infection via antibiotic administration according to guidelines after gynecological surgery

“…Many groups have investigated the potential benefit of creating, and following, SSI prevention bundles, which include preoperative treatment, prophylactic antibiotic administration, perioperative blood glucose control, intraoperative temperature management and supplemental oxygen. It is necessary to examine the necessity for drain insertion in each case, taking SSI risk into consideration . On the other hand, Pop‐Vicas et al .…”

“…It is necessary to examine the necessity for drain insertion in each case, taking SSI risk into consideration. 12,13 On the other hand, Pop-Vicas et al argued that the risk factor related to the occurrence of SSI after hysterectomy was only operative time. 14 Shortening the operative time due to acquisition of technology and suppression of complications that prolong operative time also are key points.…”

Surgical technical evidence review for gynecologic surgery conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery

“…74 In the second study of 462 patients, a multidisciplinary referral to discharge perioperative glycemic control initiative (including rigorous preoperative/intraoperative/postoperative glucose monitoring with a target blood glucose 180 mg/dL) led to a 55% reduction in SSI. 75 Summary: Perioperative blood glucose control with a goal of 180 mg/ dL is recommended to reduce the risk of SSI.…”