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Rosemarie Garcia Getting



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    P1.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 948)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/24/2018, 16:45 - 18:00, Exhibit Hall
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      P1.16-51 - Preop Nutrition-Enhanced Recovery After Surgery Protocol for Thoracic Cancer Resections Decreases Hospital Days and Charges (ID 12779)

      16:45 - 18:00  |  Author(s): Rosemarie Garcia Getting

      • Abstract
      • Slides

      Background

      Numerous studies over the last decade have documented that the preoperative nutritional status strongly influences perioperative outcomes. Based on published surgical studies, we instituted a preoperative enhanced nutritional support protocol for thoracic cancer resection patients and compared the results to a historical control cohort from the year immediately prior to starting this nutrition program.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      Patients undergoing thoracic cancer resections from July 15, 2016 to July 14, 2017 underwent a preoperative nutritional-enhanced recovery after surgery protocol (N-ERAS) of daily probiotics, five days of an oral immunonutrition drink and a complex carbohydrate loading drink the night prior to surgery. Historical controls were from patients undergoing surgery the 12 months prior (Pre-N-ERAS), all operated on by the same surgical team. Non-parametric statistical tests were employed for this retrospective analysis.

      4c3880bb027f159e801041b1021e88e8 Result

      Data from 234 patients were analyzed. For the Pre-N-ERAS group, there were 121 patients (48/73 men/women), mean age 67.5 (range 24-88), mean post-bronchodilator %FEV1 86.7±19.9 (range 41-126), mean serum albumin 4.3±0.3gm/dl (range 3.2-5.1) and mean Charlson Co-Morbidity Index 4.3±2.2 (range 0-11). For the N-ERAS group, there were 113 patients (50/63 men/women), mean age 67.5 (range 43-85), mean post-bronchodilator %FEV1 89.4±19.7 (range 43-146), mean serum albumin 4.3±0.3gm/dl (range 3.3-5.0) and mean Charlson Co-Morbidity Index 4.8±2.2 (range 1-11). There were no significant differences among the groups for demographics. For both groups, no mortalities, empyemas, wound infections or reoperations for any cause were reported. The N-ERAS nutrition protocol patient compliance was 100% with no toxicity. Compared to the Pre-N-ERAS patients, the N-ERAS group had significantly less time to return of bowel function (mean 1.30 days versus 1.11 days, p<0.001), shorter hospital stays (mean/median 4.57/4 days versus 3.63/3 days, p=0.001) and less total hospital mean charges/patient ($47,403 versus $42,979, p=0.037), respectively. This translated into approximately a 9.3% decrease ($4,424) in mean charges/patient using the N-ERAS protocol. Consequently, for the N-ERAS cohort, hospital charges were likely $499,912 lower than expected for the 113 patients.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Use of this patient-compliant N-ERAS preoperative nutrition protocol in normally nourished thoracic cancer surgical patients is associated with accelerated bowel function recovery, decreased hospital stays and lower charges. While a prospective clinical trial is warranted, thoracic surgeons should consider using N-ERAS in their major surgical patients with an expectation of improved clinical results at a lower cost--an important consideration when exploring ways to decrease charges in the prospective payment environment.

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