P-OGC02 The development of an evidence based algorithm for the provision of nutrition as part of an Enhanced Recover After Surgery (ERAS) pathway in patients undergoing elective Gastrectomy and Oesophagogastrectomy for cancer. (16th December 2021)

• Record Type: Journal Article
• Authors: Dossou, Vida; Cleary, Ally
• Is Part Of: British journal of surgery. Volume 108:Supplement 9(2021)
• Publication Date: 2021-12-16
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab430.130
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Background: Following a recent merger or UGI Cancer services, a consensus was needed for the ERAS pathway nutritional elements. ERAS is a way to maintain physiological function following surgery enabling post-operative recovery without adversely affecting morbidity or mortality. It is a coordinated pathway that enables consistent, evidence based multi-modal care. Anaesthesia, nutrition, analgesia, surgical technique and physiotherapy are active and key components of enhanced recovery along with patient involvement and empowerment. ERAS in UGI revealed a significant reduction in LOS in most cases, by around 50% without increasing morbidity and mortality when compared to standard post-operative care. Methods: Coupling the service redesign with the publication of guidelines in ERAS and Gastrectomy, it was decided to review the evidence base for ERAS and nutrition support specific to UGI Cancer surgery. In addition to this, aim to review the evidence for and against the use of immunonutrition (IN). Literature searches were conducted using CINAHL and PUBMED databases. The evidence was critiqued and a consensus reached. From this evidence review, an algorithm recommending the instigation of nutrition post Upper Gastrointestinal (UGI) surgery as part of an ERAS pathway was developed. Results: An algorithm was produced standardising the nutritional care for patients undergoing elective UGI surgery in our centre, which formed part of the ERAS care pathway produced through the ERAS steering group. All patients were screened for risk of malnutrition at the start of their surgical care pathway and regularly throughout their journey, appropriate nutritional support will be provided by a specialist Dietitian to optimise the patient. Conclusions: The evidence to support the use of IN is conflicting and is not currently recommended on this ERAS pathway. Nutritional intake in the form of Oral Nutritional Support (ONS) in subtotal gastrectomy can be commenced at Day 2. Nutritional intake in the form of ONS in Total Gastrectomy can be commenced at Day 4. Nutritional intake in the form of ONS in Oesophagogastrectomy can be commenced at Day 5. After ONS tolerated without clinical symptoms, patient can be progressed to Soups, Jellies, Ice creams for 24 hours then to an UGI specific soft menu pre discharge.