- Email: [email protected]
Should hyperoxia be included as a standard item in enhanced recovery after surgery perioperative care?
e48
Abstracts / Clinical Nutrition ESPEN 12 (2016) e30ee59
Conclusion: Implementing an ERAS programme in elective colorectal surgery: 1) significantly reduced both time to functional recovery and LOS; 2) did not increase morbidity, mortality, and 30-day readmissions; 3) significantly decreased direct costs. Disclosure of interest: None declared.
P043. A COMPREHENSIVE EVALUATION OF DIFFERENT RISK-ASSESSMENT MODELS TO PREDICT 30-DAY POSTOPERATIVE COMPLICATIONS IN GYNAECOLOGIC PATIENTS UNDERGOING SURGERY UNDER AN ENHANCED SURGICAL RECOVERY PROGRAMME (ESRP)
P042. SHOULD HYPEROXIA BE INCLUDED AS A STANDARD ITEM IN ENHANCED RECOVERY AFTER SURGERY PERIOPERATIVE CARE?
Maria D. Iniesta 1, *, Gloria Salvo 1, Larissa A. Meyer 1, Javier Lasala 2, Katherine Cain 3, Alpa M. Nick 1, Terri Earles 1, Mark Munsell 4, Pedro T. Ramirez 1. 1 Gynaecological Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, United States; 2 Anaesthesia, MD Anderson Cancer Center, Houston, United States; 3 Division of Pharmacy, MD Anderson Cancer Center, Houston, United States; 4 Biostatistics, MD Anderson Cancer Center, Houston, United States
rez, Eduard Marc Sadurni*, Laura Castelltort, Mireia Rueda, Alex Pe Soler, Fernando Escolano. Anaesthesia, Hospital del Mar, Barcelona, Spain Objectives: The application of high oxygen concentration during the perioperative period is controversial. A recent meta-analysis concludes that it decreases the risk of surgical site infection (SSI) after colon surgery. Nevertheless, some authors suggest an increase in long-term mortality. The goal of the study was to analyze if perioperative hyperoxia therapy decreases the incidence of infectious complications after elective colon surgery without increasing long-term mortality. Methods: We performed a retrospective analysis on 223 patients who underwent elective colorectal surgery between 2011 and 2013. Patients were divided into 2 groups. Hyperoxia group received perioperative (intraoperative + 2 hours postoperative) FiO2 80%. Control group received standard perioperative FiO2 (50%). SSI was recorded from a prospective collected surgeon’s database. We realised a follow-up study of long-term mortality of the patients until January 2015. Demographic, intraoperative data and cancer stage were also recorded. Statistical analysis: Quantitative data expressed as mean±standard deviation. Qualitative expressed as percentage. c2 test to analyze differences in SSI and Kaplan-Meier test to analyze differences in survival between groups. Results: 42% received hyperoxia and 58% received FiO2 50%. No differences were found in demographic, intraoperative and cancer stage between groups (table 1).
Age (years) Weight (kg) ASA status ASA II ASA III Type of surgery Right hemicolectomy Sigmoid colectomy Rectal resection Duration of surgery (minutes) Intraoperative fluid therapy (mL) Transfusion Cancer stage Stage 2 Stage >2
Hyperoxia Group (n¼94)
Control Group (n¼123)
68 ± 9 75 ± 13
70 ± 8 73 ± 12
60% 40% 100%
64% 36% 100%
26% 50% 24% 179 ± 50 1977 ± 876
33% 40% 27% 192 ± 70 1973 ± 875
16%
25%
58% 42%
60% 40%
We found 17% of SSI in the hyperoxia group vs. 24% in the control group (p¼0.2). The mean follow-up time was 2.2 years. We found no increase of mortality in the follow-up period (14% in the hyperoxia group vs. 19% in the control group) without differences in the survival curve (p¼0.60). Conclusion: Although the decrease in SSI in the hyperoxia group did not reach statistical significance, it seems to be a safe therapy without increasing mortality. We feel it could be a good practice in enhanced recovery colon surgery. Disclosure of interest: None declared.
Objectives: To analyze the accuracy of different risk assessment models in predicting postoperative complications in an Enhanced Surgical Recovery Programme (ESRP). To determine the impact of each variable in the respective risk-assessment scores in predicting 30-day postoperative complications (Accordion Grades 1 to 6) after gynaecologic surgery in a tertiary cancer centre. Methods: Patients who underwent consecutive open gynecologic surgery in an ESRP from November 2014 to November 2015 were included in the analysis. We used descriptive statistics to summarise variables of interest for those patients who had surgery before and after the ESRP. Variables were selected for each model. We used the Wilcoxon rank sum test to compare these groups with respect to medians of continuous variables. We used Fisher’s exact test to compare these groups with respect to categorical variables. We used logistic regression methods to model the logit of the probability of any postoperative complication within 30 days as a function of patient group and other factors found to be differential between the patient groups. We started with a saturated model including all factors found on univariate analysis with p<0.25 and then used backward elimination until all remaining factors were significant with p<0.05. Results: We included 272 patients in the ESRP group and 74 patients in the pre-ESRP group. There were no differences in age, ASA status, BMI, preoperative albumin, Charlson Comorbidity Index, indication for surgery, and FIGO staging between the two groups. Operative time and surgical complexity were similar in both groups, while blood loss was higher in the pre-ESRP group (300 ml vs. 400 ml)(p¼0.041). The probability of any postoperative surgical complication within 30 days of surgery was increased by 49% for each additional hour of surgery, and each unit increase in the Charlson Comorbidity Score lead to an increase of complications of 18%. Conclusion: Our Risk-Assessment Model identified surgical time and Charlson Comorbidity Index as the predictors of postoperative surgical complications in patients undergoing surgery under an ESRP for gynaecologic surgery. Disclosure of interest: None declared. P044. PROFAST: ERAS IN ADVANCED OVARIAN CANCER, A RANDOMISED TRIAL Pe rez-Benavente 1, Jose L. Melchor Carbonell Socias 1, *, Mª Assumpcio ~ oz 2, nchez-Iglesias 1, Susana Manrique-Mun Rosa BurgosSa zquez 4, Sira Pelaez 3, Monica Pamies-Serrano 4, Dolores Rubio-Va Capote 1, Berta Díaz-Feijoo 1, Oriol Puig-Puig 5, Silvia Cabrera-Díaz 1, Silvia Franco-Camps 1, Javier De la Torre 1, Blanca Gil 1, Antonio Gil Moreno 1. 1 Gynaecologic Oncology, Hospital Vall d'Hebron, Barcelona, Spain; 2 Anaesthesiology, Hospital Vall d'Hebron, Barcelona, Spain; 3 Endocrinology, Hospital Vall d'Hebron, Barcelona, Spain; 4 Oncologyc Nursery, Hospital Vall d'Hebron, Barcelona, Spain; 5 General Surgery, Hospital Vall d'Hebron, Barcelona, Spain Objectives: Enhanced Recovery After Surgery (ERAS), has been shown to reduce Hospitalisation by more than 30% without increasing the rate of complications or readmissions. However, information on the results of ERAS protocols when applied to advanced gynaecological cancer is sparse. Our hypothesis was that the application of an ERAS protocol in the
Abstracts / Clinical Nutrition ESPEN 12 (2016) e30ee59
Conclusion: Implementing an ERAS programme in elective colorectal surgery: 1) significantly reduced both time to functional recovery and LOS; 2) did not increase morbidity, mortality, and 30-day readmissions; 3) significantly decreased direct costs. Disclosure of interest: None declared.
P043. A COMPREHENSIVE EVALUATION OF DIFFERENT RISK-ASSESSMENT MODELS TO PREDICT 30-DAY POSTOPERATIVE COMPLICATIONS IN GYNAECOLOGIC PATIENTS UNDERGOING SURGERY UNDER AN ENHANCED SURGICAL RECOVERY PROGRAMME (ESRP)
P042. SHOULD HYPEROXIA BE INCLUDED AS A STANDARD ITEM IN ENHANCED RECOVERY AFTER SURGERY PERIOPERATIVE CARE?
Maria D. Iniesta 1, *, Gloria Salvo 1, Larissa A. Meyer 1, Javier Lasala 2, Katherine Cain 3, Alpa M. Nick 1, Terri Earles 1, Mark Munsell 4, Pedro T. Ramirez 1. 1 Gynaecological Oncology and Reproductive Medicine, MD Anderson Cancer Center, Houston, United States; 2 Anaesthesia, MD Anderson Cancer Center, Houston, United States; 3 Division of Pharmacy, MD Anderson Cancer Center, Houston, United States; 4 Biostatistics, MD Anderson Cancer Center, Houston, United States
rez, Eduard Marc Sadurni*, Laura Castelltort, Mireia Rueda, Alex Pe Soler, Fernando Escolano. Anaesthesia, Hospital del Mar, Barcelona, Spain Objectives: The application of high oxygen concentration during the perioperative period is controversial. A recent meta-analysis concludes that it decreases the risk of surgical site infection (SSI) after colon surgery. Nevertheless, some authors suggest an increase in long-term mortality. The goal of the study was to analyze if perioperative hyperoxia therapy decreases the incidence of infectious complications after elective colon surgery without increasing long-term mortality. Methods: We performed a retrospective analysis on 223 patients who underwent elective colorectal surgery between 2011 and 2013. Patients were divided into 2 groups. Hyperoxia group received perioperative (intraoperative + 2 hours postoperative) FiO2 80%. Control group received standard perioperative FiO2 (50%). SSI was recorded from a prospective collected surgeon’s database. We realised a follow-up study of long-term mortality of the patients until January 2015. Demographic, intraoperative data and cancer stage were also recorded. Statistical analysis: Quantitative data expressed as mean±standard deviation. Qualitative expressed as percentage. c2 test to analyze differences in SSI and Kaplan-Meier test to analyze differences in survival between groups. Results: 42% received hyperoxia and 58% received FiO2 50%. No differences were found in demographic, intraoperative and cancer stage between groups (table 1).
Age (years) Weight (kg) ASA status ASA II ASA III Type of surgery Right hemicolectomy Sigmoid colectomy Rectal resection Duration of surgery (minutes) Intraoperative fluid therapy (mL) Transfusion Cancer stage Stage 2 Stage >2
Hyperoxia Group (n¼94)
Control Group (n¼123)
68 ± 9 75 ± 13
70 ± 8 73 ± 12
60% 40% 100%
64% 36% 100%
26% 50% 24% 179 ± 50 1977 ± 876
33% 40% 27% 192 ± 70 1973 ± 875
16%
25%
58% 42%
60% 40%
We found 17% of SSI in the hyperoxia group vs. 24% in the control group (p¼0.2). The mean follow-up time was 2.2 years. We found no increase of mortality in the follow-up period (14% in the hyperoxia group vs. 19% in the control group) without differences in the survival curve (p¼0.60). Conclusion: Although the decrease in SSI in the hyperoxia group did not reach statistical significance, it seems to be a safe therapy without increasing mortality. We feel it could be a good practice in enhanced recovery colon surgery. Disclosure of interest: None declared.
Objectives: To analyze the accuracy of different risk assessment models in predicting postoperative complications in an Enhanced Surgical Recovery Programme (ESRP). To determine the impact of each variable in the respective risk-assessment scores in predicting 30-day postoperative complications (Accordion Grades 1 to 6) after gynaecologic surgery in a tertiary cancer centre. Methods: Patients who underwent consecutive open gynecologic surgery in an ESRP from November 2014 to November 2015 were included in the analysis. We used descriptive statistics to summarise variables of interest for those patients who had surgery before and after the ESRP. Variables were selected for each model. We used the Wilcoxon rank sum test to compare these groups with respect to medians of continuous variables. We used Fisher’s exact test to compare these groups with respect to categorical variables. We used logistic regression methods to model the logit of the probability of any postoperative complication within 30 days as a function of patient group and other factors found to be differential between the patient groups. We started with a saturated model including all factors found on univariate analysis with p<0.25 and then used backward elimination until all remaining factors were significant with p<0.05. Results: We included 272 patients in the ESRP group and 74 patients in the pre-ESRP group. There were no differences in age, ASA status, BMI, preoperative albumin, Charlson Comorbidity Index, indication for surgery, and FIGO staging between the two groups. Operative time and surgical complexity were similar in both groups, while blood loss was higher in the pre-ESRP group (300 ml vs. 400 ml)(p¼0.041). The probability of any postoperative surgical complication within 30 days of surgery was increased by 49% for each additional hour of surgery, and each unit increase in the Charlson Comorbidity Score lead to an increase of complications of 18%. Conclusion: Our Risk-Assessment Model identified surgical time and Charlson Comorbidity Index as the predictors of postoperative surgical complications in patients undergoing surgery under an ESRP for gynaecologic surgery. Disclosure of interest: None declared. P044. PROFAST: ERAS IN ADVANCED OVARIAN CANCER, A RANDOMISED TRIAL Pe rez-Benavente 1, Jose L. Melchor Carbonell Socias 1, *, Mª Assumpcio ~ oz 2, nchez-Iglesias 1, Susana Manrique-Mun Rosa BurgosSa zquez 4, Sira Pelaez 3, Monica Pamies-Serrano 4, Dolores Rubio-Va Capote 1, Berta Díaz-Feijoo 1, Oriol Puig-Puig 5, Silvia Cabrera-Díaz 1, Silvia Franco-Camps 1, Javier De la Torre 1, Blanca Gil 1, Antonio Gil Moreno 1. 1 Gynaecologic Oncology, Hospital Vall d'Hebron, Barcelona, Spain; 2 Anaesthesiology, Hospital Vall d'Hebron, Barcelona, Spain; 3 Endocrinology, Hospital Vall d'Hebron, Barcelona, Spain; 4 Oncologyc Nursery, Hospital Vall d'Hebron, Barcelona, Spain; 5 General Surgery, Hospital Vall d'Hebron, Barcelona, Spain Objectives: Enhanced Recovery After Surgery (ERAS), has been shown to reduce Hospitalisation by more than 30% without increasing the rate of complications or readmissions. However, information on the results of ERAS protocols when applied to advanced gynaecological cancer is sparse. Our hypothesis was that the application of an ERAS protocol in the