Data from 2015 were collected prospectively in the EIAS database. ... spective database is e helpful tool to monitor results and compliance to the ... RECOVERY.
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Abstracts / Clinical Nutrition ESPEN 12 (2016) e30ee59
P024. ERAS FOR RADICAL CYSTECTOMY-FIRST YEAR RESULTS IMPLEMENTATION OF ERAS USING THE EIAS DATABASE
AFTER
Gunder Lilleaasen 1, *, Jalil Davami 1, Karol Axcrona 2, Stig Müller 2, 3. 1 Akershus University Hospital, Lørenskog, Norway; 2 Dept of Urology, Akershus University Hospital, Lørenskog, Norway; 3 Institute of Clinical Medicine, University of Oslo, Oslo, Norway Objectives: Radical cystectomy is associated with significant morbidity, ranging between 30 and 60%1. Before 2015, we have implemented some ERAS items for cystectomy patients without a prospective database. We evaluated the results and compliance with the ERAS protocol using the ERAS Interactive Audit System (EIAS) database (Encare®) one year after implementation of a full ERAS protocol. Methods: We compared the results of 2014 (pre-ERAS) and 2015 (after implementation of full ERAS protocol) with regards to length of stay, complications and compliance to ERAS items. The results of 2014 were collected retrospectively by patient chart review as a part of the ERAS implementation programme. Data from 2015 were collected prospectively in the EIAS database. Results: The main outcomes are shown in the table. There was a trend towards a reduction in overall complications. Length of stay and highgrade complications were unchanged in the first year of our ERAS programme.
N ERAS Compliance (total) Mean operation duration (hours) Median LOS (days) Age range (years) ASA I-II ASA III-IV Complications (any grade) Serious complications Reoperations
2014
2015
Pre ERAS
ERAS
37 49.3% 4.09 h 10 41-79 25 12 51.4 % 10.8 % 10.8%
37 68% 4.34 h 10 56-84 23 14 37.8 % 10.8 % 8.3%
Conclusion: The implementation of a full ERAS protocol including the use of a prospective database has not reduced length of stay or high-grade complications. While we achieved 100% for some of the ERAS items (e.g. PONV prophylaxis, no bowel preparation, no sedatives), some items in the postoperative period have been difficult to implement. The use of a prospective database is e helpful tool to monitor results and compliance to the ERAS protocol. References: 1. Cerantola Y, et al. Clin Nutr 2013;32:879-87 Disclosure of interest: None declared. P025. STARTING HAEMOGLOBIN IN OESOPHAGECTOMY AFFECTS VASOPRESSOR AND BLOOD TRANSFUSION REQUIREMENT e A NEED FOR PRE-OPERATIVE OPTIMISATION? Ian Lyons 1, *, Oliver Griffith 1, Arun Nair 1, Simon Parsons 2, Adam Carney 1. 1 Anaesthetics, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom; 2 Upper GI Surgery, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom Objectives: Blood loss is a potential complication during oesophagectomy, and may be confounded by pre-existing anaemia. Intraoperative transfusion is associated with poorer late term outcomes in oesophageal cancer1 and vasopressors used to treat hypotension may impact anastomotic perfusion2. We assessed transfusion and fluid optimisation (GDFT) during oesophagectomy and its effect on perioperative noradrenaline (NA) use.
Methods: 258 consecutive sets of notes from patients undergoing oesophagectomy between 2012 and 2015 were audited. Results: The mean haemoglobin (Hb) was 124±17 g/L. 38 patients (14.7%) received packed red blood cells (PRBC) within 48 hours of surgery. The likelihood of transfusion increased with lower starting Hb (p¼0.003). Where starting Hb was below 120 g/L (Group A), 10 of 93 patients received intraoperative PRBC (11%). With a starting Hb above 120 g/L (Group B), 11 of 165 patients received intraoperative PRBC (6.7%). The median volume transfused was the same in both groups (580 vs. 589 ml). In Group A, NA use at 24 hours post-op decreased from 22.9% (19/83 cases) to 0% with PRBC (0/10 cases; p
