SP6.2.1 Dysphagia in the perioperative period: Preliminary audit of pre-operative weight loss in patients undergoing oesophago-gastrectomy for primary locally advanced oesophageal cancer. (9th August 2022) - Russell, Claire
Abstract: Background: Malnutrition and dysphagia are highly prevalent in patients with oesophageal cancer. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard to describe oral intake for dysphagic individuals. Greater weight loss (WL) after oesophago-gastrectomy is associated with increased length of stay (LOS), rate of post-operative complications and worse five-year survival, placing a burden on resources. This audit aimed to determine associations between pre-operative IDDSI scores, WL and post-operative morbidity. Methods: A retrospective audit of patients undergoing oesophago-gastrectomy for locally advanced oesophageal cancer was conducted in a single tertiary cancer centre between 2017 and 2018. Pre-operative WL was compared with IDDSI scores, post-treatment WL, post-operative complications, Critical Care Unit (CCU) and inpatient LOS. Results: 78 patients were included, 65 male and 13 female with mean age 64 (range 40 to 80). Median pre-operative percentage WL was greater in patients with moderate dysphagia (IDDSI 5-6) than those with a normal swallow (IDDSI 7), though not statistically significantly. There were 26 Grade 3/4 Clavien-Dindo complications. Pre-operative WL correlated with rate of complications, and WL five to seven months post-operatively (p=0.04, p=0.001). Greater pre-operative WL correlated with a longer CCU LOS and total inpatient LOS, but this was non-significant (p=0.09, p=0.07). Conclusions: IDDSI scores 5/6 may be early indicators for nutritional intervention in the peri-operative pathway. Each clinical interaction in the cancer pathway provides an opportunity to identify and correct malnutrition and improve outcomes. A criteria-specific nutritional pathway has been implemented to optimise patients peri-operatively. A prospective re-audit will indicate improvements on patient-related and oncological outcomes.