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MON-PP267: To Evaluate the Outcomes of Enhanced Recovery after Surgery Program and Physical Activity in Patients Who Have Undergone Thoracic Esophageal Cancer Surgery
S226 Conclusion: Sarcopenia was very common in the present series of pancreatic cancer patients undergoing PD. The combination of visceral obesity and sarcopenia significantly predicted postoperative mortality. Disclosure of Interest: None declared
MON-PP267 TO EVALUATE THE OUTCOMES OF ENHANCED RECOVERY AFTER SURGERY PROGRAM AND PHYSICAL ACTIVITY IN PATIENTS WHO HAVE UNDERGONE THORACIC ESOPHAGEAL CANCER SURGERY H. Sato1 , S. Sakuramoto1 , I. Koyama2 . 1 Esophagogastric Surgery, 2 Gastrointestinal Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan Rationale: Cardiopulmonary exercise testing (CPX) is a noninvasive, objective method of assessing integrated response of the heart, lungs, and musculoskeletal system to incremental exercise. This study aimed to evaluate the impact of an enhanced recovery after surgery (ERAS) program and physical activity using CPX in patients who underwent a transthoracic esophagectomy. Methods: Between April 2012 and October 2014, 34 patients who underwent a transthoracic esophagectomy were enrolled into the ERAS program that included early postoperative enteral nutrition and mobilization. Each patient was evaluated using CPX on both the day of an admission day (pre) and day of discharge (post). The program was started on the first postoperative day (POD 1). Outcome metrics comprised morbidity rate, average postoperative days when the patients started walking, postoperative pneumonia, surgical site infection (SSI), length of postoperative hospital stay, peakVO2, peak workload, and anaerobic threshold (AT). Results: Morbidity, postoperative pneumonia, SSI, and readmission rates were 35%, 3.0%, 12%, and 3.0%, respectively. The average postoperative period when the patients started walking was 1.3 (range, 1 3) days. The average postoperative hospital stay was 23.9 (range, 8 107) days. PeakVO2 (mL/kg/min) was 21.9±4.4 (pre) and 17.0±3.7 (post) (p < 0.01). Peak workload (watt) was 101.8±23.5 (pre) and 76.5±22.0 (post) (p < 0.01). AT (mL/kg/min) was 12.6±2.2 (pre) and 11.3±1.7 (post) (p < 0.01). The rates of decrease for peak VO2 was 26.4%. Conclusion: This ERAS program was found to reduce the morbidity rate, particularly infectious complications, compared with previous reports. Physical activity on the day of discharge decreased by approximately 25% and 4.9 METS which was calculated based on peakVO2. This level is not enough to keep quality of life. Disclosure of Interest: None declared
Poster presentations MON-PP268 EFFICACY OF INTRAVENOUS FAT EMULSION CONTAINING OMEGA-3 FATTY ACIDS ON CLINICAL OUTCOMES OF SURGICAL PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS H.J. Bae1,2 , G.Y. Lee2 , J.-M. Seong3 , H.S. Gwak2 . 1 Department of Pharmacy, Seoul National University Hospital, 2 Ewha Womans University, 3 Korea Institute of Drug Safety and Risk Management, Seoul, Korea, Republic of Rationale: Omega-3 fatty acids have been identified as potentially important components of immune-modulation artificial nutrition in surgical patients. The currently available intravenous fat emulsions (IVFEs) are based with soybean oil (SO), medium chain triglyceride, olive oil, or fish oil (FO). To evaluate the effect FO-based IVFEs on the clinical outcomes of surgical patients, a meta-analysis of randomized controlled trials (RCTs) was conducted. Methods: Computerized searches of MEDLINE, EMBASE, and Cochran CENTRAL were performed in August 2014. RCTs comparing FO-based IVFEs with conventional IVFEs in surgical patients receiving parenteral nutrition were included. RevMan 5.3 was used for statistical analysis. Results: A total of 19 RCTs with 1167 patients were included in the present study. FO-based IVFEs were associated with a reduction in infectious morbidity (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.29 0.63; P < 0.0001; heterogeneity I2 = 0%) and a reduction in the length of hospital stay (LOS) (weighted mean difference, 1.81; 95% CI 2.89 to 0.74; P = 0.0009; heterogeneity I2 = 60%). No significant difference was found in mortality (OR, 1.20; 95% CI, 0.46 3.12; P = 0.72; heterogeneity I2 = 0%). The subgroup analysis comparing FObased IVFEs to each conventional IVFEs was performed, the overall effect size of infectious morbidity and LOS was greatest when compared to the SO-based IVFEs. Conclusion: Based on the meta-analysis, it can be concluded that FO-based IVFEs improve infectious morbidity and LOS. Further research is needed to identify which IVFE oils or which combination of oils may be most clinically useful for surgical patients. Disclosure of Interest: None declared
MON-PP269 INTRAOPERATIVE GOAL-DIRECTED FLUID THERAPY IN ELECTIVE MAJOR ABDOMINAL SURGERY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS K.E. Rollins1 , D.N. Lobo1 . 1 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom Rationale: Studies published in the first decade of the 21st century suggested that GDFT resulted in a significant reduction in postoperative morbidity compared with conventional intraoperative fluid therapy. However, more recent trials within ERAS settings have suggested there is no significant difference. The aims of this meta-analysis were to a) compare the effects of intraoperative goal-directed fluid therapy with conventional fluid therapy, and b) determine whether there was a difference in outcome between studies that did and did not use ERAS protocols. Methods: A meta-analysis of randomized controlled trials was conducted of adult patients undergoing elective major
MON-PP267 TO EVALUATE THE OUTCOMES OF ENHANCED RECOVERY AFTER SURGERY PROGRAM AND PHYSICAL ACTIVITY IN PATIENTS WHO HAVE UNDERGONE THORACIC ESOPHAGEAL CANCER SURGERY H. Sato1 , S. Sakuramoto1 , I. Koyama2 . 1 Esophagogastric Surgery, 2 Gastrointestinal Surgery, Saitama International Medical Center, Saitama Medical University, Hidaka-shi, Saitama, Japan Rationale: Cardiopulmonary exercise testing (CPX) is a noninvasive, objective method of assessing integrated response of the heart, lungs, and musculoskeletal system to incremental exercise. This study aimed to evaluate the impact of an enhanced recovery after surgery (ERAS) program and physical activity using CPX in patients who underwent a transthoracic esophagectomy. Methods: Between April 2012 and October 2014, 34 patients who underwent a transthoracic esophagectomy were enrolled into the ERAS program that included early postoperative enteral nutrition and mobilization. Each patient was evaluated using CPX on both the day of an admission day (pre) and day of discharge (post). The program was started on the first postoperative day (POD 1). Outcome metrics comprised morbidity rate, average postoperative days when the patients started walking, postoperative pneumonia, surgical site infection (SSI), length of postoperative hospital stay, peakVO2, peak workload, and anaerobic threshold (AT). Results: Morbidity, postoperative pneumonia, SSI, and readmission rates were 35%, 3.0%, 12%, and 3.0%, respectively. The average postoperative period when the patients started walking was 1.3 (range, 1 3) days. The average postoperative hospital stay was 23.9 (range, 8 107) days. PeakVO2 (mL/kg/min) was 21.9±4.4 (pre) and 17.0±3.7 (post) (p < 0.01). Peak workload (watt) was 101.8±23.5 (pre) and 76.5±22.0 (post) (p < 0.01). AT (mL/kg/min) was 12.6±2.2 (pre) and 11.3±1.7 (post) (p < 0.01). The rates of decrease for peak VO2 was 26.4%. Conclusion: This ERAS program was found to reduce the morbidity rate, particularly infectious complications, compared with previous reports. Physical activity on the day of discharge decreased by approximately 25% and 4.9 METS which was calculated based on peakVO2. This level is not enough to keep quality of life. Disclosure of Interest: None declared
Poster presentations MON-PP268 EFFICACY OF INTRAVENOUS FAT EMULSION CONTAINING OMEGA-3 FATTY ACIDS ON CLINICAL OUTCOMES OF SURGICAL PATIENTS: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS H.J. Bae1,2 , G.Y. Lee2 , J.-M. Seong3 , H.S. Gwak2 . 1 Department of Pharmacy, Seoul National University Hospital, 2 Ewha Womans University, 3 Korea Institute of Drug Safety and Risk Management, Seoul, Korea, Republic of Rationale: Omega-3 fatty acids have been identified as potentially important components of immune-modulation artificial nutrition in surgical patients. The currently available intravenous fat emulsions (IVFEs) are based with soybean oil (SO), medium chain triglyceride, olive oil, or fish oil (FO). To evaluate the effect FO-based IVFEs on the clinical outcomes of surgical patients, a meta-analysis of randomized controlled trials (RCTs) was conducted. Methods: Computerized searches of MEDLINE, EMBASE, and Cochran CENTRAL were performed in August 2014. RCTs comparing FO-based IVFEs with conventional IVFEs in surgical patients receiving parenteral nutrition were included. RevMan 5.3 was used for statistical analysis. Results: A total of 19 RCTs with 1167 patients were included in the present study. FO-based IVFEs were associated with a reduction in infectious morbidity (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.29 0.63; P < 0.0001; heterogeneity I2 = 0%) and a reduction in the length of hospital stay (LOS) (weighted mean difference, 1.81; 95% CI 2.89 to 0.74; P = 0.0009; heterogeneity I2 = 60%). No significant difference was found in mortality (OR, 1.20; 95% CI, 0.46 3.12; P = 0.72; heterogeneity I2 = 0%). The subgroup analysis comparing FObased IVFEs to each conventional IVFEs was performed, the overall effect size of infectious morbidity and LOS was greatest when compared to the SO-based IVFEs. Conclusion: Based on the meta-analysis, it can be concluded that FO-based IVFEs improve infectious morbidity and LOS. Further research is needed to identify which IVFE oils or which combination of oils may be most clinically useful for surgical patients. Disclosure of Interest: None declared
MON-PP269 INTRAOPERATIVE GOAL-DIRECTED FLUID THERAPY IN ELECTIVE MAJOR ABDOMINAL SURGERY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS K.E. Rollins1 , D.N. Lobo1 . 1 Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom Rationale: Studies published in the first decade of the 21st century suggested that GDFT resulted in a significant reduction in postoperative morbidity compared with conventional intraoperative fluid therapy. However, more recent trials within ERAS settings have suggested there is no significant difference. The aims of this meta-analysis were to a) compare the effects of intraoperative goal-directed fluid therapy with conventional fluid therapy, and b) determine whether there was a difference in outcome between studies that did and did not use ERAS protocols. Methods: A meta-analysis of randomized controlled trials was conducted of adult patients undergoing elective major