- Email: [email protected]
450. Surgical oncological elderly patients – QoL after ICU
ABSTRACTS
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procedures, it was possible to have an important contribution to increase patient safety. Conclusions: ChiBaseÓ meets all standards to implement evidence based medicine in daily clinical routine with high safety standards. It provides high data quality and security, data independence and redundancydepleting. By ensuring seamless and complete documentation our DBMS supports highest level of quality assurance for best patient safety. No conflict of interest.
We correlated EORTC QLQ-C30 with demographic variables, reason for admission, days of ICU stay, SAPS II and survival time since ICU. Conclusion: Age is no longer a reason per si for not operating elderly oncological patients. They are a frail population and concerns about the judicious use of health care resources should be based on existing evidence of the results and benefits to patients which are intrinsically related to the evaluation of their QOL. No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.437
http://dx.doi.org/10.1016/j.ejso.2014.08.438
450. Surgical oncological elderly patients e QoL after ICU C. Carneiro1, D. Oliveira1, S. Tavares1, R. Rocha1, R. Marinho1, A. Gomes1, M. Sousa1, T. Brand~ao2, I. Braga2, V. Nunes1 1 Hospital Prof. Dr. Fernando Fonseca, Surgery, Lisboa, Portugal 2 Hospital Prof. Dr. Fernando Fonseca, Intensive Care Unit, Lisboa, Portugal
451. Collection of perioperative outcome data A. Burston1, D. Dunne1, G. Poston1, H. Malik1, S. Fenwick1 1 Aintree University Hospital, General Surgery, Liverpool, United Kingdom
Background: Cancer is increasing in our society and is a relevant health problem in older people. Intensive care treatment has important economical, social and personal costs, with important consequences on quality of life (QOL). Our aim was to evaluate QOL of elderly patients (65 or older) operated for an oncological tumour and treated in ICU for organ failure and to study predictive factors for QOL in these patients. Materials: We conducted a retrospective cohort study followed by a QOL survey on surgical elderly oncological patients treated in ICU for organ dysfunction from January 2008 to December 2013. We analyzed patients’ demographic and clinical parameters, number of ICU days, number of mechanical ventilation days, SAPS II, total hospitalization days and survival time since ICU. We applied EORTC QLQ-C30 (version 3.0) questionnaire to all living patients that consented on answering the survey by phone. Parametric and non-parametric tests and logistic regression were used. Results: During this period our surgical ICU treated 2139 patients, of this 796 were oncological surgical elderly patients. We excluded 462 patients admitted for post operative surveillance, 46 who died in the intensive care unit and 128 who died on follow-up. We then analyzed data from 160: 88 males (55%), mean age 75,8y (range 65e88y). SAPS II 41,6 (range 15e93). Mean days of mechanical ventilation of 3,4 days (range 0e20). Mean days of ICU stay 3,6 (range 3e33). Then we contacted all of them by phone and invited them to answer the QOL questionnaire.
Introduction: Accurately measuring perioperative outcomes is a key requirement of surgical services. Hospital coding is often used in large studies to evaluate perioperative outcomes. This coding data is typically collated by, non-clinically trained, clerical staff. The Liverpool Hepatobiliary Centre has an ethically approved research database with prospective clinician led collation of data. This study sought to evaluate the accuracy of hospital coding against a prospective clinician led database. Methods: A prospective clinician led system of complication recording was introduced in 2008. All data was collated prospectively and analysed retrospectively. A six-month time frame was identified from 8/2013. All Data was validated by monthly consultant review. The clinician led data was compared to the hospital-collated data for accuracy. Results: A total of 57 patients underwent hepatectomy during this time period. Median hospital length of stay was 6 days (IQR 5e7). Hospital length of stay was identical in both cohorts. A total of 19 (33%) patients suffered complications. Hospital coding reported only 4 (7%) patients with complications. This was significantly different between datasets (p < 0.01), with accurate correlation only achieved in 36 (63%) of patients. Conclusions: Hospital Coding is unsuitable for analysis of postoperative complications. Clinician led data should be essential for assessment of perioperative complications, and requires a robust prospective system of collation. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.439
Poster Session: Regional Cancer Treatment 452. Neuroendocrine tumours: Are current management guidelines practicable in developing countries? T. Madiba1, P.N. Mthethwa1 1 UKZN Nelson R Mandela School of Medicine, Department of Surgery, Durban, South Africa Background: Neuroendocrine tumours (NETs) represent a heterogeneous group of tumours. Although rare they are increasingly being diagnosed in our setting. Aim: To evaluate hospital prevalence and clinicopathologic characteristics of NETs and to establish if our management approaches compare to international norms. Methods: Retrospective analysis of an on-going prospectively collected NET database into which all patients with NETs from the KwaZulu-Natal (KZN) Province of South Africa are enrolled. Patients are discussed at the Multidisciplinary clinic where treatment decisions are made. Data extracted included demographics, clinical presentation, disease distribution, staging, grading, treatment and follow-up. Results: Thirty patients have been enrolled over 13 years, including Africans (12, 40%), Indians (12, 40%), Whites (4, 13%) and Coloured
(2, 6.7%). Thirteen were male and median age was 53.5 years. Change of bowel habit was the predominant presenting feature. Median duration of symptoms was 6.5 months. Four patients presented with tumour complications. The sites were foregut (11), midgut (6), hindgut (12) and unknown primary (1). The common specific primary sites were the rectum (8) and pancreas (6). Seventeen patients presented with metastatic disease with the liver being the most common target organ. The WHO grading was I (3), II (1) and III (27). Seventeen patients underwent resection resulting in R-0, R-1 and R-2 resection in 14, 2, 1 patients respectively. Patients received somatostatin or its analogues (11), chemotherapy (9) or no treatment (10). Median follow-up was 13 months. Four patients have developed new metastases during treatment, two of which were successfully treated with resection. Ten patients (33%) have been confirmed to have died. Conclusion: Neuroendocrine tumours are an established disease which affects all population groups in KZN Province. Carcinoma is the most common histology. Foregut and hindgut tumours are more common. Late presentation is a problem. One third present with metastatic disease. Treatment approach and outcome is comparable to international trends.
S171
procedures, it was possible to have an important contribution to increase patient safety. Conclusions: ChiBaseÓ meets all standards to implement evidence based medicine in daily clinical routine with high safety standards. It provides high data quality and security, data independence and redundancydepleting. By ensuring seamless and complete documentation our DBMS supports highest level of quality assurance for best patient safety. No conflict of interest.
We correlated EORTC QLQ-C30 with demographic variables, reason for admission, days of ICU stay, SAPS II and survival time since ICU. Conclusion: Age is no longer a reason per si for not operating elderly oncological patients. They are a frail population and concerns about the judicious use of health care resources should be based on existing evidence of the results and benefits to patients which are intrinsically related to the evaluation of their QOL. No conflict of interest.
http://dx.doi.org/10.1016/j.ejso.2014.08.437
http://dx.doi.org/10.1016/j.ejso.2014.08.438
450. Surgical oncological elderly patients e QoL after ICU C. Carneiro1, D. Oliveira1, S. Tavares1, R. Rocha1, R. Marinho1, A. Gomes1, M. Sousa1, T. Brand~ao2, I. Braga2, V. Nunes1 1 Hospital Prof. Dr. Fernando Fonseca, Surgery, Lisboa, Portugal 2 Hospital Prof. Dr. Fernando Fonseca, Intensive Care Unit, Lisboa, Portugal
451. Collection of perioperative outcome data A. Burston1, D. Dunne1, G. Poston1, H. Malik1, S. Fenwick1 1 Aintree University Hospital, General Surgery, Liverpool, United Kingdom
Background: Cancer is increasing in our society and is a relevant health problem in older people. Intensive care treatment has important economical, social and personal costs, with important consequences on quality of life (QOL). Our aim was to evaluate QOL of elderly patients (65 or older) operated for an oncological tumour and treated in ICU for organ failure and to study predictive factors for QOL in these patients. Materials: We conducted a retrospective cohort study followed by a QOL survey on surgical elderly oncological patients treated in ICU for organ dysfunction from January 2008 to December 2013. We analyzed patients’ demographic and clinical parameters, number of ICU days, number of mechanical ventilation days, SAPS II, total hospitalization days and survival time since ICU. We applied EORTC QLQ-C30 (version 3.0) questionnaire to all living patients that consented on answering the survey by phone. Parametric and non-parametric tests and logistic regression were used. Results: During this period our surgical ICU treated 2139 patients, of this 796 were oncological surgical elderly patients. We excluded 462 patients admitted for post operative surveillance, 46 who died in the intensive care unit and 128 who died on follow-up. We then analyzed data from 160: 88 males (55%), mean age 75,8y (range 65e88y). SAPS II 41,6 (range 15e93). Mean days of mechanical ventilation of 3,4 days (range 0e20). Mean days of ICU stay 3,6 (range 3e33). Then we contacted all of them by phone and invited them to answer the QOL questionnaire.
Introduction: Accurately measuring perioperative outcomes is a key requirement of surgical services. Hospital coding is often used in large studies to evaluate perioperative outcomes. This coding data is typically collated by, non-clinically trained, clerical staff. The Liverpool Hepatobiliary Centre has an ethically approved research database with prospective clinician led collation of data. This study sought to evaluate the accuracy of hospital coding against a prospective clinician led database. Methods: A prospective clinician led system of complication recording was introduced in 2008. All data was collated prospectively and analysed retrospectively. A six-month time frame was identified from 8/2013. All Data was validated by monthly consultant review. The clinician led data was compared to the hospital-collated data for accuracy. Results: A total of 57 patients underwent hepatectomy during this time period. Median hospital length of stay was 6 days (IQR 5e7). Hospital length of stay was identical in both cohorts. A total of 19 (33%) patients suffered complications. Hospital coding reported only 4 (7%) patients with complications. This was significantly different between datasets (p < 0.01), with accurate correlation only achieved in 36 (63%) of patients. Conclusions: Hospital Coding is unsuitable for analysis of postoperative complications. Clinician led data should be essential for assessment of perioperative complications, and requires a robust prospective system of collation. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.439
Poster Session: Regional Cancer Treatment 452. Neuroendocrine tumours: Are current management guidelines practicable in developing countries? T. Madiba1, P.N. Mthethwa1 1 UKZN Nelson R Mandela School of Medicine, Department of Surgery, Durban, South Africa Background: Neuroendocrine tumours (NETs) represent a heterogeneous group of tumours. Although rare they are increasingly being diagnosed in our setting. Aim: To evaluate hospital prevalence and clinicopathologic characteristics of NETs and to establish if our management approaches compare to international norms. Methods: Retrospective analysis of an on-going prospectively collected NET database into which all patients with NETs from the KwaZulu-Natal (KZN) Province of South Africa are enrolled. Patients are discussed at the Multidisciplinary clinic where treatment decisions are made. Data extracted included demographics, clinical presentation, disease distribution, staging, grading, treatment and follow-up. Results: Thirty patients have been enrolled over 13 years, including Africans (12, 40%), Indians (12, 40%), Whites (4, 13%) and Coloured
(2, 6.7%). Thirteen were male and median age was 53.5 years. Change of bowel habit was the predominant presenting feature. Median duration of symptoms was 6.5 months. Four patients presented with tumour complications. The sites were foregut (11), midgut (6), hindgut (12) and unknown primary (1). The common specific primary sites were the rectum (8) and pancreas (6). Seventeen patients presented with metastatic disease with the liver being the most common target organ. The WHO grading was I (3), II (1) and III (27). Seventeen patients underwent resection resulting in R-0, R-1 and R-2 resection in 14, 2, 1 patients respectively. Patients received somatostatin or its analogues (11), chemotherapy (9) or no treatment (10). Median follow-up was 13 months. Four patients have developed new metastases during treatment, two of which were successfully treated with resection. Ten patients (33%) have been confirmed to have died. Conclusion: Neuroendocrine tumours are an established disease which affects all population groups in KZN Province. Carcinoma is the most common histology. Foregut and hindgut tumours are more common. Late presentation is a problem. One third present with metastatic disease. Treatment approach and outcome is comparable to international trends.