MON-P236: Influence Of Sarcopenia On Infectious Complications in Patients Undergoing Pancreaticoduodenectomy

Perioperative care Results: Sarcopenia was associated with increased risk of infectious complications (OR = 3.78; p < 0.0001). Non-immunonutrition was also associated with increased risk of infectious complications (OR = 2.64; p = 0.0002). Other factors of complications after PD such as pancreas texture (OR = 1.71), pancreatic duct diameter (OR = 1.87) and biliary drainage (OR = 1.59) were associated with increased risk of infectious complications (all p < 0.05). After a multivariate analysis, sarcopenia (OR = 2.94; p = 0.0005) and non-immunonutrition (OR = 3.29; p < 0.0001) remained independently associated with an increased risk of infectious complications. In nonsarcopenic patients the odds ratio between immunonutrition and infectious complications was 1.95, whereas in sarcopenic patients the odds ratio between immunonutrition and infectious complications was 10.91. Conclusion: Immunonutrition is the effective strategy for sarcopenic patients at higher risk of infectious complications after PD. Disclosure of Interest: None declared

MON-P234 THE EFFECT OF LEUCOCYTE PLATELET RICH PLASMA (L-PRP) ADMINISTRERED IN THE WOUND ON HEALING AFTER HIP ARTHROPLASTY H. B. Jørgensen1, S. C. Capion1, H. Daugaard2, S. RibelMadsen2, P. I. Johansson3, J. Salado3, P. M. H. Jensen1, A. Borgwardt2, J. R. Andersen1. 1Department of Nutrition, Exercise and Sports, University of Copenhagen, 2Department of Orto-Paedic Surgery, Frederiksberg Hospital, 3Department of Clinical Immunology, Rigshospitalet, Copenhagen, Denmark Rationale: Based on good results in animal models we wanted to investigate if local application of L-PRP can enhance wound healing after total hip arthroplasty with optimal postoperative diet in well-nouriched patients. Methods: Unblinded randomized controlled trial for 4 weeks post-operatively (weekly controls). Intervention (16 patients): 6–20 mL L-PRP subcutaneously (on the fascial layer) at wound closure. Both groups had 1.5 g protein/kg/d (Arla Protino®) + daily nutritional supplements (5 g L-arginine, 44mg zinc and 500mg vitamin C). L-PRP was produced by centrifugation. Controls: 17 patients. Wound healing: total healing of the skin judged visually. Registrations: Wound temperature, mobilization (Timed Up & Go), physical function (questionnaire), pain (VAS), analgetic dose, compliance, energy-protein intake, length of hospital stay, post operative blood transfusions and infections. Results: The wounds healed significantly faster in the intervention group after 3 weeks (7 vs 0) and 4 weeks (12 vs 6). The temperature difference between hips was significantly larger in the intervention group as was the physical functional level. There was no difference in pain registration or analgetic doses after 3, 4 or 5 weeks. The compliance to the diet and nutritional supplements was high in both groups. There was no difference in post operative blood transfusions or length of stay. No infections were observed. Conclusion: Subcutaneously applied L-PRP had a significant effect on the healing of the skin after total hip arthroplasty when combined with L-arginine, zinc, vitamin C and a high protein diet. The method used for evaluation of the skin healing was the traditional inspection, which is not optimal, but the

S239 golden standard at the moment. The effect on the temperature is probably due to the healing activity. The effects on variables not directly related to the wound are difficult to explain. Disclosure of Interest: None declared

MON-P235 STUDY OF THE EFFECTS OF TARGET-ORIENTED FLUID THERAPY IS GIVEN TO PROMOTING RECOVERY AFTER SURGERY - INTERVENTION COMPARATIVE OBSERVATION RESEARCH IN THE PATIENTS APPLIED TO ENHANCED RECOVERY OF AFTER SURGERY PROTOCOL H. Taniguchi1, K. Ushigome1, T. Sasaki2, H. Fujita2, T. Ogata3. 1 Preoperative Support Center, Saiseikai Yokohama-shi Tobu Hospital, 2Anesthesiology, 3Gastrointestinal Surgery, Kanagawa cancer center, Yokohama, Japan Rationale: This study aims to elucidate the impact of transfusion protocols in perioperative management of esophageal cancer on postoperative recovery of patients. Methods: This study included patients who underwent elective esophagectomy and were managed according to the modified enhanced recovery after surgery (M-ERAS) program. They were divided into two groups for comparison: Group H including patients who received intraoperative and postoperative management consisting of liberal transfusion and the M-ERAS program (n = 43, historical data) and Group S including patients who received management consisting of goal-directed transfusion (GDT) and the M-ERAS program (n = 49, GDT-ERAS). The primary endpoint was the rate of gastrointestinal functional recovery, which was assessed by monitoring the daily fluctuations in gastrografin (GG) levels. The secondary endpoints were the level of achieved postoperative mobilization. Results: The proportion of patients who excreted GG from the body on postoperative day 4, level of achieved postoperative mobilization, and success rate of walking 100 m in the first postoperative attempt of ambulation were significantly higher in Group S than in Group H ( p = 0.034, p = 0.0197, and p < 0.0001, respectively). The serum albumin levels on postoperative days 0, 1, and 2 and at the time of discharge and 6 months after discharge were higher in Group S than in Group H ( p < 0.0001, p < 0.0001, p < 0.0001, p = 0.0015, and p = 0.0002, respectively). Conclusion: The GDT-ERAS program enhanced postoperative peristaltic movement of the intestine and postoperative mobilization. Regarding postoperative nutritional status, protein synthesis was enhanced. Disclosure of Interest: None declared

MON-P236 INFLUENCE OF SARCOPENIA ON INFECTIOUS COMPLICATIONS IN PATIENTS UNDERGOING PANCREATICODUODENECTOMY K. Furukawa1, A. Furukawa1, D. Suzuki1, H. Shimizu1, M. Ohtsuka1, A. Kato1, H. Yoshitomi1, T. Takayashiki1, S. Kuboki1, S. Takano1, N. Sakai1, S. Kagawa1, H. Nojima1, M. Miyazaki1. 1Department of General Surgery, Chiba University, Graduate School of Medicine, Chiba, Japan Rationale: It has been recently reported that sarcopenia is highly associated with postoperative morbidity rate in patients who underwent different types of surgeries. Few studies have examined the association between the presence of sarcopenia

S240 and morbidity following pancreaticoduodenectomy. The purpose of this study was to investigate the influence of sarcopenia on infectious complications in patients undergoing pancreaticoduodenectomy. Methods: This study included 309 patients who underwent pancreaticoduodenectomy from 2009 to 2015 (200 men and 109 women). We estimated muscle mass by computed tomography. The third lumbar vertebrae (L3) was chosen as a standard landmark and two consecutive CT images extending from L3 to the iliac crest were chosen to measure muscle cross-sectional area. Cross-sectional areas (cm2) of the sum of all of muscles were computed for each image, the mean value for the two images was computed for each patient, and a skeletal muscle mass index (SMI) was defined as cross-sectional areas/height2 (cm2/m2). Sarcopenia was defined as the presence of a SMI in the lowest sex-specific quartile. We investigated the influence of sarcopenia on postoperative complications in 223 patients who underwent pancreaticoduodenectomy. Eighty-six patients who received immunonutrition were excluded from this analysis. Results: In the 223 patients, 61 patients were classified as sarcopenia and 162 patients were classified as non-sarcopenia. The rate of infectious complications in patients with sarcopenia (81.9%) was significantly higher than that in patients without sarcopenia (44.4%) ( p < 0.001). There were no differences in the rate of non-infectious complications between sarcopenia and non-sarcopenia patients. Conclusion: Sarcopenia was the risk factor for infectious complications after pancreaticoduodenectomy. Disclosure of Interest: None declared

MON-P237 USING A KT FRAMEWORK TO PLAN FOR SPREAD AND SCALE OF ENHANCED RECOVERY L. M. Gramlich1, G. Nelson2, T. Wasylak3, J. Lawrence4. 1 University of Alberta, Edmonton, 2University of Calgary, 3 Alberta Health Services, Calgary, 4Albertahealthservices, Edmonton, Canada Rationale: Between 2013 and 2015, Alberta Health Services implemented ERAS in colorectal surgery at six unique sites, accounting for 75% of all colorectal surgery. The purpose of this study is to describe the development and application of a Knowledge Tranlsation framework to support the spread and scale of ERAS. Methods: We applied the Theoretic Domains Framework and the QUERI model to create a Knowledge translation framework. Existing care gaps were identified through the ERAS Interactive Audit System. Information was gathered from multiple sources and coded to evaluate barriers and enablers to change in practice. Practice changes occurring with ERAS implementation were identified by comparing compliance with the guideline before and after implementation. In order to address the development of sustainable change at the system level, we identified features relating to organizational culture, capacity building and the system characteristics. Results: ERAS was implemented in 2440 patients at 6 sites between 2013 and 2015. Compliance to the guideline at baseline was 45% and after implementation was 70%. The biggest changes in compliance were noted in the pre- and postoperative periods. Clinical themes, including Nutrition,

Poster Mobilization, Pain and Symptom Control, Hydration and Modern Fasting Guidelines accounted for 23% of implementation considerations. Other implementation considerations identified included education (18%), data/audit (15%), teams (13%), tools (9%), communication (6%) and resources (6%). From the system perspective, creating capacity accounted for 44%, clinical are elements 23%, supportive systems 20%, and culture to effect change 6% of all feedback. Conclusion: To inform spread and scale of ERAS, key clinical features for implementation have been identified. Successful implementation cannot occur with focus on clinical elements alone as capacity, supportive systems and culture are integral to system change. Disclosure of Interest: None declared

MON-P238 DIETARY INTAKE DURING HOSPITALIZATION AFTER PANCREATICODUODENECTOMY; DO WE ACHIEVE OUR AIM? M. Borremans1,2, M. V. D. Linden1,2, G. V. D. Berg1,2, T. Bisseling2, M. V. D. Kolk3, M. V. D. Berg2. 1HAN University of Applied Sciences, 2Department of Gastro-enterology, 3 Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands Rationale: Protein requirements after pancreaticoduodenectomy (PD) are difficult to achieve. Anatomical and functional changes result in less enteral intake during the first postoperative days. Aim of this study was to determine which part of the patients after PD achieve their individual minimum protein requirement, which feeding strategy was used and how weight developed during hospitalization. Methods: In the Radboud University Medical Centre a retrospective cohort study was carried out in all patients who underwent PD between February 2013 and November 2015 for pancreatic, periampullary, biliary and duodenal adenocarcinoma. Protein intake relative to individual protein requirement (1.2 g per kilogram bodyweight), feeding strategy and change in bodyweight were studied in two periods during hospitalization: (1) postoperative day (POD) one until five (2) POD six until ten. Results: Sixty-seven patients were included (43 men; median age 66 yr, IQR 60–72). Median coverage of protein intake related to minimum protein requirement during the first and second period was respectively 108% (n = 54; IQR, 60–128) and 95% (n = 56; IQR, 45–120). The amount of patients who reached their protein requirement (≥100%) was respectively 56% and 43%. During both periods most patients who reached their protein requirement received total parental nutrition (TPN) respectively 97% and 83%. In the first period a weight gain of 2.4% (IQR −0.2–5.6) was obtained as result of a positive fluid balance (1963 mL, IQR 494–3,832). In the second period observed weight loss was 2.5% (IQR 4.4–0.1). Conclusion: In almost 50% of the patients protein requirement was achieved in the first ten days after PD, specific nutritional attention should those who did not achieve protein requirement. TPN seems an effective feeding strategy to achieve protein requirement during the first days after PD. The first ten days after PD there is no overall change in weight. Disclosure of Interest: None declared