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Tu1762 Changing Trends in Acute Colonic Diverticulitis in South East Queensland - A Retrospective Observational Audit
Tu1760
supplemental oxygen compared to low FiO2 was observed in the entire cohort (RR 0.883, CI 0.722-1.081, p=0.227). Four trials involved 910 patients specifically undergoing elective colorectal resections. Among these RCTs, patients receiving high FiO2 supplemental oxygen had a 44.4% reduction in SSI rate compared to the low FiO2 group (RR 0.556, CI 0.3940.785, p=0.001). Conclusion: Supernormal FiO2 supplementation in the immediate postoperative period did not demonstrate a significant benefit in regards to reducing SSI rate for the entire cohort including all major general and gynecologic surgery. When supernormal FiO2 supplementation was provided specifically to colorectal patients, a 44.4% reduction in the SSI risk was observed. High FiO2 supplementation to colorectal patients in the immediate post-operative period is a simple, inexpensive, and safe intervention which may improve SSI rates following elective colorectal cases, and should be considered in all patients. Additional studies are needed to better determine which colorectal patients (laparoscopic vs. open; right vs. left vs. pelvic) are most likely to benefit from perioperative high inspired oxygen supplementation.
Neutrophil Count, but Not Other Components of a White Cell Count, Reflects the Impact of the Systemic Inflammatory Response and Long Term Survival in Patients Following Elective Surgery for Colorectal Cancer David G. Watt, James H. Park, Michelle L. Ramanathan, Paul G. Horgan, Donald C. McMillan Background It has recently been reported that the magnitude of the post-operative systemic inflammatory response can be assessed by monitoring the concentrations of C-reactive protein (CRP) but not a white cell count (WCC). Although the majority of white cells are neutrophils, there are other cells that are included and these may respond differently following surgical intervention. Furthermore, pre-operative systemic inflammatory scoring systems such as the Neutrophil Lymphocyte Ratio (NLR) have been described in many solid organ cancers and shown to have prognostic value. However, different NLR thresholds have been reported for its clinical utility. Therefore, the aim of the present study was to determine which of the components of the WCC were involved in predicting short and long term outcomes in patients undergoing elective surgery for colorectal cancer (CRC). Methods Patients with histologically proven CRC who were considered to have undergone potentially curative resection were studied. 2 patient cohorts were examined. Short term outcomes (cohort 1) were examined in 378 patients and were performed using open (n = 291) or laparoscopic (n = 87) surgery. Daily blood samples to measure CRP and differential WCC were taken routinely in the perioperative period and patients were assessed for post-operative complications. Long term outcomes were examined in 508 patients (cohort 2). Pre-operative CRP and differential WCC were measured and their association with cancer-specific (CSS) and overall survival (OS) were examined. Results In cohort 1, only the neutrophil and monocyte count significantly increased following surgery (lymphocytes, eosinophils, basophils and platelets were lower), peaking on post-operative day 1 and were significantly different to pre-operative values (all p < 0.001). Laparoscopic surgery was associated with lower neutrophil counts but higher lymphocyte counts (both p < 0.01) compared with open procedures. Compared with no complications, infective complications were associated with greater neutrophil counts from post-operative day 3 (p < 0.01) but lymphocyte counts were not altered. In cohort 2, there were 172 cancer deaths and 120 non-cancer deaths. On Kaplan Meier analysis age, TNM stage, venous invasion, margin involvement, peritoneal involvement, tumour perforation, white cell and neutrophil count (all p<0.05) were associated with CSS. In those with node negative colon cancer (n=226), on multivariate analysis, age, venous invasion, and neutrophil count (all p<0.05) were independently associated with CSS. Conclusions Of the components of a WCC, only the neutrophil count reflected the impact of the magnitude of injury, development of infective complications and was independently associated with cancer-specific survival. Therefore, it is likely that the prognostic value of the NLR is mainly determined by the neutrophil count. Table 1. The magnitude of the neutrophil count in patients undergoing open and laparoscopic procedures and developing infective and no complications following elective colorectal cancer resection
Changing Trends in Acute Colonic Diverticulitis in South East Queensland - A Retrospective Observational Audit Aung Win, Jaskiran Kaur, Christopher Gillespie, Sneha John Background:The clinical burden of acute colonic diverticulitis is high with nearly 300,000 admissions annually in the US.While diverticulitis is thought to be a disease of the elderly,recent trends suggest an increase in the number of young patients with this condition.It has also been suggested that they may require a greater number of admissions.In South East Queensland, we have noted a significant number of admissions with acute diverticulitis in young patients.The aetiological factors are unclear. Aim:To identify the age stratification of patients admitted with acute colonic diverticulitis to a single institution over a 16 month period and any disease or patient specific characteristics in the younger age group. Methods:This was a retrospective observational audit from March 2012 to August 2013.All patients admitted with a clinical diagnosis of acute colonic diverticulitis were considered.Inclusion criteria was the radiological confirmation of the diagnosis by a CT scan reported by an experienced Radiologist.Data was analysed to separate the patients into 3 age groups;< 45 years,45-65 years and >65 years. We also recorded a history of smoking,aspirin use and diabetes status.CT findings were separated into uncomplicated and complicated disease based on the presence of perforation,abscess,fistulae,strictures or a mass. Results: A total of 305 patients were admitted to a single institution with diverticulitis in the study period and 155 patients met the inclusion criteria.There were 83 women and 72 men in the study. 31 % of the patients were under the age of 45 years, 46.5% were 45-65 years and 22.5% were above 65 years.The median age was 53 years (range 24-93);this was 55years in women and 48 years in men.36 patients had complicated diverticulitis with CT findings of perforations in 26 patients with10 abscesses and10 fistulae.Strictures were seen on CT in 10 patients and one was reported to have a mass.Surgery was required in 10 patients. 44% of the patients with complicated disease were under 45 years.This was statistically significant with a p value of 0.049. Smoking, diabetes and aspirin use did not have statistically significant effects on severity of presentation. Discussion. There are significant changes in the age related demographics of acute diverticulitis in recent years. In our study the median age was 53years with 31% of the study population under 45 years. Interestingly, 44% of complicated disease was also in the younger population. This is very different from previously reported data from the US and Australia .The study is limited by its retrospective design and the possibility of bias. However, it reflects the changing trends in acute colonic diverticulitis with increased admissions with more complex disease in the younger population in our area. The aetiological factors are uncertain and a prospective multi -centre study is planned.
Tu1761 Perioperative Supplemental Oxygen Reduces the Risk of Surgical Site Infection in Colorectal Surgery: A Meta-Analysis Varun Chakravorty, Ronald S. Chamberlain Introduction: Despite advances in surgical technique and perioperative care, surgical site infection (SSI) remains one of the most common nosocomial infections in surgical patients. Post-operative patients are routinely placed on supplemental oxygen in the PACU to maintain adequate oxygen saturation and are monitored by pulse oximetry. While oxygen has been shown to play a vital role in oxidative killing of pathogenic bacteria by neutrophils, whether hyperoxia can further decrease SSI rates remains controversial. Multiple randomized controlled trials (RCT) and previous meta-analyses on this topic have failed to reach a consensus. This meta-analysis analyzes all existing RCTs involving major general and gynecologic surgery in an effort to determine whether the perioperative delivery of supernormal concentrations of supplemental oxygen can effect SSI rates. Method: A comprehensive search of PubMed, Google Scholar, and the Cochrane and NIH registry of clinical trials was performed. RCTs assessing the impact of perioperative supplemental oxygen (high and low concentrations) following major general and gynecologic surgery on SSI rates were included. High concentrations were defined as > to a fractional inspired oxygen (FiO2) of 80%, while low concentration supplemental oxygen was a FiO2 of 30%. Subgroup analysis was performed for elective colorectal resections. Results: 15 trials involving 7,574 patients were included in the metaanalysis. No significant difference in SSI risk between patients that received high FiO2
S-1175
SSAT Abstracts
SSAT Abstracts
Tu1762
supplemental oxygen compared to low FiO2 was observed in the entire cohort (RR 0.883, CI 0.722-1.081, p=0.227). Four trials involved 910 patients specifically undergoing elective colorectal resections. Among these RCTs, patients receiving high FiO2 supplemental oxygen had a 44.4% reduction in SSI rate compared to the low FiO2 group (RR 0.556, CI 0.3940.785, p=0.001). Conclusion: Supernormal FiO2 supplementation in the immediate postoperative period did not demonstrate a significant benefit in regards to reducing SSI rate for the entire cohort including all major general and gynecologic surgery. When supernormal FiO2 supplementation was provided specifically to colorectal patients, a 44.4% reduction in the SSI risk was observed. High FiO2 supplementation to colorectal patients in the immediate post-operative period is a simple, inexpensive, and safe intervention which may improve SSI rates following elective colorectal cases, and should be considered in all patients. Additional studies are needed to better determine which colorectal patients (laparoscopic vs. open; right vs. left vs. pelvic) are most likely to benefit from perioperative high inspired oxygen supplementation.
Neutrophil Count, but Not Other Components of a White Cell Count, Reflects the Impact of the Systemic Inflammatory Response and Long Term Survival in Patients Following Elective Surgery for Colorectal Cancer David G. Watt, James H. Park, Michelle L. Ramanathan, Paul G. Horgan, Donald C. McMillan Background It has recently been reported that the magnitude of the post-operative systemic inflammatory response can be assessed by monitoring the concentrations of C-reactive protein (CRP) but not a white cell count (WCC). Although the majority of white cells are neutrophils, there are other cells that are included and these may respond differently following surgical intervention. Furthermore, pre-operative systemic inflammatory scoring systems such as the Neutrophil Lymphocyte Ratio (NLR) have been described in many solid organ cancers and shown to have prognostic value. However, different NLR thresholds have been reported for its clinical utility. Therefore, the aim of the present study was to determine which of the components of the WCC were involved in predicting short and long term outcomes in patients undergoing elective surgery for colorectal cancer (CRC). Methods Patients with histologically proven CRC who were considered to have undergone potentially curative resection were studied. 2 patient cohorts were examined. Short term outcomes (cohort 1) were examined in 378 patients and were performed using open (n = 291) or laparoscopic (n = 87) surgery. Daily blood samples to measure CRP and differential WCC were taken routinely in the perioperative period and patients were assessed for post-operative complications. Long term outcomes were examined in 508 patients (cohort 2). Pre-operative CRP and differential WCC were measured and their association with cancer-specific (CSS) and overall survival (OS) were examined. Results In cohort 1, only the neutrophil and monocyte count significantly increased following surgery (lymphocytes, eosinophils, basophils and platelets were lower), peaking on post-operative day 1 and were significantly different to pre-operative values (all p < 0.001). Laparoscopic surgery was associated with lower neutrophil counts but higher lymphocyte counts (both p < 0.01) compared with open procedures. Compared with no complications, infective complications were associated with greater neutrophil counts from post-operative day 3 (p < 0.01) but lymphocyte counts were not altered. In cohort 2, there were 172 cancer deaths and 120 non-cancer deaths. On Kaplan Meier analysis age, TNM stage, venous invasion, margin involvement, peritoneal involvement, tumour perforation, white cell and neutrophil count (all p<0.05) were associated with CSS. In those with node negative colon cancer (n=226), on multivariate analysis, age, venous invasion, and neutrophil count (all p<0.05) were independently associated with CSS. Conclusions Of the components of a WCC, only the neutrophil count reflected the impact of the magnitude of injury, development of infective complications and was independently associated with cancer-specific survival. Therefore, it is likely that the prognostic value of the NLR is mainly determined by the neutrophil count. Table 1. The magnitude of the neutrophil count in patients undergoing open and laparoscopic procedures and developing infective and no complications following elective colorectal cancer resection
Changing Trends in Acute Colonic Diverticulitis in South East Queensland - A Retrospective Observational Audit Aung Win, Jaskiran Kaur, Christopher Gillespie, Sneha John Background:The clinical burden of acute colonic diverticulitis is high with nearly 300,000 admissions annually in the US.While diverticulitis is thought to be a disease of the elderly,recent trends suggest an increase in the number of young patients with this condition.It has also been suggested that they may require a greater number of admissions.In South East Queensland, we have noted a significant number of admissions with acute diverticulitis in young patients.The aetiological factors are unclear. Aim:To identify the age stratification of patients admitted with acute colonic diverticulitis to a single institution over a 16 month period and any disease or patient specific characteristics in the younger age group. Methods:This was a retrospective observational audit from March 2012 to August 2013.All patients admitted with a clinical diagnosis of acute colonic diverticulitis were considered.Inclusion criteria was the radiological confirmation of the diagnosis by a CT scan reported by an experienced Radiologist.Data was analysed to separate the patients into 3 age groups;< 45 years,45-65 years and >65 years. We also recorded a history of smoking,aspirin use and diabetes status.CT findings were separated into uncomplicated and complicated disease based on the presence of perforation,abscess,fistulae,strictures or a mass. Results: A total of 305 patients were admitted to a single institution with diverticulitis in the study period and 155 patients met the inclusion criteria.There were 83 women and 72 men in the study. 31 % of the patients were under the age of 45 years, 46.5% were 45-65 years and 22.5% were above 65 years.The median age was 53 years (range 24-93);this was 55years in women and 48 years in men.36 patients had complicated diverticulitis with CT findings of perforations in 26 patients with10 abscesses and10 fistulae.Strictures were seen on CT in 10 patients and one was reported to have a mass.Surgery was required in 10 patients. 44% of the patients with complicated disease were under 45 years.This was statistically significant with a p value of 0.049. Smoking, diabetes and aspirin use did not have statistically significant effects on severity of presentation. Discussion. There are significant changes in the age related demographics of acute diverticulitis in recent years. In our study the median age was 53years with 31% of the study population under 45 years. Interestingly, 44% of complicated disease was also in the younger population. This is very different from previously reported data from the US and Australia .The study is limited by its retrospective design and the possibility of bias. However, it reflects the changing trends in acute colonic diverticulitis with increased admissions with more complex disease in the younger population in our area. The aetiological factors are uncertain and a prospective multi -centre study is planned.
Tu1761 Perioperative Supplemental Oxygen Reduces the Risk of Surgical Site Infection in Colorectal Surgery: A Meta-Analysis Varun Chakravorty, Ronald S. Chamberlain Introduction: Despite advances in surgical technique and perioperative care, surgical site infection (SSI) remains one of the most common nosocomial infections in surgical patients. Post-operative patients are routinely placed on supplemental oxygen in the PACU to maintain adequate oxygen saturation and are monitored by pulse oximetry. While oxygen has been shown to play a vital role in oxidative killing of pathogenic bacteria by neutrophils, whether hyperoxia can further decrease SSI rates remains controversial. Multiple randomized controlled trials (RCT) and previous meta-analyses on this topic have failed to reach a consensus. This meta-analysis analyzes all existing RCTs involving major general and gynecologic surgery in an effort to determine whether the perioperative delivery of supernormal concentrations of supplemental oxygen can effect SSI rates. Method: A comprehensive search of PubMed, Google Scholar, and the Cochrane and NIH registry of clinical trials was performed. RCTs assessing the impact of perioperative supplemental oxygen (high and low concentrations) following major general and gynecologic surgery on SSI rates were included. High concentrations were defined as > to a fractional inspired oxygen (FiO2) of 80%, while low concentration supplemental oxygen was a FiO2 of 30%. Subgroup analysis was performed for elective colorectal resections. Results: 15 trials involving 7,574 patients were included in the metaanalysis. No significant difference in SSI risk between patients that received high FiO2
S-1175
SSAT Abstracts
SSAT Abstracts
Tu1762