PWE-099 Audit of elective and emergency surgery for crohn’s disease at a district general hospital: is there a role for exclusive enteral nutrition and the specialist ibd dietician?

• Published in: Gut Vol. 66; no. Suppl 2; p. A177
• Main Authors: Patel, RN, Corrigall, D, Syme, G, Hay, V, Hammond, T, Saverymuttu, S, Shah, R
• Format: Journal Article
• Language: English
• Published: 01.07.2017
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gutjnl-2017-314472.345

IntroductionRecent evidence shows that pre-operative exclusive enteral nutrition (EEN) in stricturing and penetrating Crohn’s disease is associated with better outcomes after surgery (1). We have audited our use of pre-operative EEN in Crohn’s disease patients at a large district general hospital (DGH) over a 5 year period and described outcomes in both emergency and elective admissions.MethodWe present the demographics and outcomes of adult patients with Crohn’s disease who had resections over a 5 year period (Jan 2012 to Dec 2016) at a DGH in south east England. To obtain the electronic discharge summaries we used the diagnosis and procedure codes for ‘Crohn’s disease’ and ‘Digestive Tract’ from the ICD-10 and OPCS classification of surgical operations and procedures, respectively. We reviewed whether patients were seen by a dietician in the 6 months prior to surgery or if EEN was trialled within 6 weeks of surgery.ResultsDistribution of Crohn’s disease; Small bowel 32 (39%), Crohn’s colitis 32 (39%), Ileo-colonic 18 (22%). Type of surgery; Small bowel resection 20 (24.4%), Ileo-colonic resection 24 (29.3%), Right/Left hemicolectomy 17 (20.7%), Proctectomy=5 (6.1%), Subtotal colectomy 4 (4.9%), Total colectomy 9 (11%), Panproctocolectomy 3 (3.7%).Table to compare Crohn’s patients who underwent surgical resection, divided by type of admission. Total n=82 Emergency n=40 Elective n=42 p values Mean Age 42.4 43.7 41.2 p>0.05 Gender M:F 43:39 23:17 20:22 p>0.05 Length of stay (days) 14 21.7 7.5 *p<0.05 Stoma 26 (31.7%) 16 (40%) 10 (23.8%) p>0.05 Steroids on admission 18 (22%) 11 (27.5%) 7 (16.6%) p>0.05 Azathioprine on admission 21 (25.6%) 9 (22.5%) 11 (26.2%) p>0.05 Complications post operatively 23 (28%) 15 (37.5%) 8 (19%) p>0.05 Seen by dietician in the 6 weeks prior to surgery 11 (13.4%) 5 (12.5%) 6 (14.2%) p>0.05 Tried EEN in the 6 weeks prior to surgery 10 (12.2%) 4 (10%) 6 (14.3%) p>0.0 ConclusionOnly 1 in 8 patients are being treated with EEN prior to surgery at our centre. Collaboration with a specialist IBD dietician and introduction of a formal pre-operative EEN protocol will be offered to optimise patients before surgery. The ratio of elective to emergency surgery (1:1) indicates a need for a more proactive approach in preparing patients for operative intervention to reduce complications and prolonged admissions.References. Heerasing N. et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn’s disease. Aliment Pharmacol Ther. 2017Mar;45(5):660–669.Disclosure of InterestNone Declared