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

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

Background: Cardiothoracic 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. Design: Open pilot feasibility study Setting: Diabetes and cardiothoracic surgery departments, University Hospital Southampton NHS Foundation Trust Participants: Seventeen people with diabetes undergoing cardiothoracic surgery Intervention: Following two rapid literature reviews, a prototype intervention was developed based on a previously used nurse-led outpatient intervention and tested. Primary outcome: Feasibility and acceptability of delivering the intervention Secondary outcomes: Biomedical 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. Results: Thirteen 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. Conclusion: This 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 registration: ISRCTN; ISRCTN10170306. Registered 10 May 2018.

Cardiothoracic surgery, Diabetes, HbA, In-patient, Service provision, Surgical outcomes
2055-5784
Holt, Richard
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Barnard-Kelly, Katharine
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Dritsakis, Georgios
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Thorne, Kerensa
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Cohen, Lauren
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Dixon, Elizabeth
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Patel, Mayank
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Newland-Jones, Philip
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Patridge, Helen
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Luthra, Suvitesh
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Ohri, Sunil
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Salhiyyah, Kareem
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Picot, Joanna
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Niven, John
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Cook, Andrew
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OCTOPuS Study Group
Holt, Richard
d54202e1-fcf6-4a17-a320-9f32d7024393
Barnard-Kelly, Katharine
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Dritsakis, Georgios
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Thorne, Kerensa
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Cohen, Lauren
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Dixon, Elizabeth
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Patel, Mayank
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Newland-Jones, Philip
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Patridge, Helen
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Luthra, Suvitesh
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Ohri, Sunil
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Salhiyyah, Kareem
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Picot, Joanna
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Niven, John
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Cook, Andrew
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Holt, Richard, Barnard-Kelly, Katharine, Dritsakis, Georgios, Thorne, Kerensa, Cohen, Lauren, Dixon, Elizabeth, Patel, Mayank and Cook, Andrew , OCTOPuS Study Group (2021) Developing an intervention to optimise the outcome of cardiac surgery in people with diabetes: the OCTOPuS pilot study. Pilot and Feasibility Studies, 7 (1), [157]. (doi:10.1186/s40814-021-00887-z).

Record type: Article

Abstract

Background: Cardiothoracic 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. Design: Open pilot feasibility study Setting: Diabetes and cardiothoracic surgery departments, University Hospital Southampton NHS Foundation Trust Participants: Seventeen people with diabetes undergoing cardiothoracic surgery Intervention: Following two rapid literature reviews, a prototype intervention was developed based on a previously used nurse-led outpatient intervention and tested. Primary outcome: Feasibility and acceptability of delivering the intervention Secondary outcomes: Biomedical 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. Results: Thirteen 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. Conclusion: This 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 registration: ISRCTN; ISRCTN10170306. Registered 10 May 2018.

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Accepted/In Press date: 9 July 2021
e-pub ahead of print date: 17 August 2021
Published date: 17 August 2021
Additional Information: Funding Information: The OCTOPuS project is funded by the UK National Institute for Health Research (NIHR) [Health Technology Assessment programme (grant number 16/25/12)]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding Information: Members of the OCTOPuS team: Theodore Velissaris UHS diabetes team: Paula Johnson, Rita Trodden, Mark Green UHS R&D nurses: Jana Rojkova, Thea Sass, Jo Stanley, Alexandra Collier CTU data team: Susi Renz, Jess Boxall, Josh Northey, Louise Stanton, Amy Whitehead Trial Steering Committee: Ketan Dhatariya (chair), Debbie Stanisstreet, Kamran Baig, Merryn Voysey, Donna Drinkwater Southampton Health Technology Assessments Centre: Joanne Lord, Jonathan Shepherd Publisher Copyright: © 2021, The Author(s).
Keywords: Cardiothoracic surgery, Diabetes, HbA, In-patient, Service provision, Surgical outcomes

Identifiers

Local EPrints ID: 451247
URI: http://eprints.soton.ac.uk/id/eprint/451247
ISSN: 2055-5784
PURE UUID: 7a0b0540-7c6d-416d-8828-987159116dcc
ORCID for Richard Holt: ORCID iD orcid.org/0000-0001-8911-6744
ORCID for Georgios Dritsakis: ORCID iD orcid.org/0000-0002-2746-963X
ORCID for Joanna Picot: ORCID iD orcid.org/0000-0001-5987-996X
ORCID for Andrew Cook: ORCID iD orcid.org/0000-0002-6680-439X

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Date deposited: 14 Sep 2021 21:00
Last modified: 17 Mar 2024 03:06

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Contributors

Author: Richard Holt ORCID iD
Author: Katharine Barnard-Kelly
Author: Georgios Dritsakis ORCID iD
Author: Kerensa Thorne
Author: Lauren Cohen
Author: Elizabeth Dixon
Author: Mayank Patel
Author: Philip Newland-Jones
Author: Helen Patridge
Author: Suvitesh Luthra
Author: Sunil Ohri
Author: Kareem Salhiyyah
Author: Joanna Picot ORCID iD
Author: John Niven
Author: Andrew Cook ORCID iD
Corporate Author: OCTOPuS Study Group

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