改善接受择期手术的糖尿病患者的围手术期路径：IP3D 项目。

Improving the peri-operative pathway of people with diabetes undergoing elective surgery: the IP3D project.

机构信息

East Suffolk and North Essex NHS Foundation Trust, Ipswich Hospital, Ipswich, UK.

University Hospitals Southampton NHS Trust, Southampton, UK.

出版信息

Diabet Med. 2020 Dec;37(12):2019-2026. doi: 10.1111/dme.14307. Epub 2020 May 13.

DOI:10.1111/dme.14307

PMID:32297351

Abstract

AIM

To determine whether outcomes for people with diabetes undergoing elective surgery improve following the introduction of innovations in the peri-operative care pathway.

METHODS

Following a baseline audit of 185 people with diabetes listed for elective surgery (July to December 2017) with a length of stay > 24 hours, a number of changes in practice were implemented. These included dissemination of a 'diabetes peri-operative passport' to participants preoperatively, formation of a diabetes surgery working group, recruitment of surgical diabetes champions and the roll-out of surgical diabetes study days. Crucial was recruitment of a diabetes peri-operative nurse, whose role included engaging and educating others and supporting individuals throughout their peri-operative diabetes care. Records of 166 individuals listed for surgery during the implementation period (July to December 2018) were then audited using the same methodology.

RESULTS

The availability of a recent HbA measurement significantly increased (63% vs 92%; P ≤ 0.001). The mean HbA of those seen for optimizations by the diabetes peri-operative nurse significantly decreased [84 mmol/mol (9.8%) vs 62 mmol/mol (7.8%); P ≤ 0.001]. Recurrent hypoglycaemia significantly decreased (7.0% vs 0.6%; P = 0.002) and the mean number of hyperglycaemic events in people experiencing hyperglycaemia almost halved (3.0 vs 1.7; P=0.007). The mean length of hospital stay significantly decreased (4.8 vs 3.3 days; P=0.001) and, crucially, 30-day readmissions did not increase (12% vs 9%; P=0.307). Postoperative complications significantly decreased (28% vs 16%; P=0.008), including a composite of dysglycaemic complications, poor wound healing, wound infection and other infections (12% vs 5.4%; P=0.023).

CONCLUSION

The new pathway improved important peri-operative outcomes for people with diabetes undergoing elective surgery with the potential for cost savings. These findings could have important implications for peri-operative care on a wider scale.

摘要

目的

确定在围手术期护理路径中引入创新后，接受择期手术的糖尿病患者的结局是否得到改善。

方法

对 185 名糖尿病患者（2017 年 7 月至 12 月，住院时间>24 小时）进行基线审计后，实施了多项实践改变。这些改变包括在术前向参与者发放“糖尿病围手术期护照”，成立糖尿病手术工作组，招募手术糖尿病冠军，以及开展手术糖尿病研究日。关键是招募一名糖尿病围手术期护士，其角色包括与他人接触和教育，并在整个围手术期糖尿病护理过程中支持个人。然后，使用相同的方法对实施期间（2018 年 7 月至 12 月）列出的 166 名手术患者的记录进行了审核。

结果

最近 HbA 测量的可用性显著增加（63%对 92%；P≤0.001）。接受糖尿病围手术期护士优化治疗的患者的平均 HbA 显著降低[84mmol/mol（9.8%）对 62mmol/mol（7.8%）；P≤0.001]。复发性低血糖显著减少（7.0%对 0.6%；P=0.002），经历高血糖的患者的高血糖事件平均数量减少近一半（3.0 次对 1.7 次；P=0.007）。平均住院时间显著缩短（4.8 天对 3.3 天；P=0.001），重要的是，30 天再入院率没有增加（12%对 9%；P=0.307）。术后并发症显著减少（28%对 16%；P=0.008），包括血糖异常并发症、伤口愈合不良、伤口感染和其他感染的综合情况（12%对 5.4%；P=0.023）。