Developing an intervention to optimise the outcome of cardiac surgery in people with diabetes: the OCTOPuS pilot study

摘要

BackgroundCardiothoracic surgical outcomes are poorer in people with diabetes compared with those without diabetes. There are two important uncertainties in the management of people with diabetes undergoing major surgery: (1) how to improve diabetes management in the weeks leading up to an elective procedure and (2) whether that improved management leads to improved postoperative outcomes. The aim of this study was to develop and pilot a specialist diabetes team-led intervention to improve surgical outcomes in people with diabetes.DesignOpen pilot feasibility studySettingDiabetes and cardiothoracic surgery departments, University Hospital Southampton NHS Foundation TrustParticipantsSeventeen people with diabetes undergoing cardiothoracic surgeryInterventionFollowing two rapid literature reviews, a prototype intervention was developed based on a previously used nurse-led outpatient intervention and tested.Primary outcomeFeasibility and acceptability of delivering the interventionSecondary outcomesBiomedical data were collected at baseline and prior to surgery. We assessed how the intervention was used. In depth qualitative interviews with participants and healthcare professionals were used to explore perceptions and experiences of the intervention and how it might be improved.ResultsThirteen of the 17 people recruited completed the study and underwent cardiothoracic surgery. All components of the OCTOPuS intervention were used, but not all parts were used for all participants. Minor changes were made to the intervention as a result of feedback from the participants and healthcare professionals. Median (IQR) HbA_(1c) was 10 mmol/mol (3, 13) lower prior to surgery than at baseline.ConclusionThis study has shown that it is possible to develop a clinical pathway to improve diabetes management prior to admission. The clinical and cost-effectiveness of this intervention will now be tested in a multicentre randomised controlled trial in cardiothoracic centres across the UK.Trial registrationISRCTN; ISRCTN10170306. Registered 10 May 2018.