MAKING AN IMPACT ON PATIENT RECOVERY: AN ANALYSIS OF AN ENHANCED RECOVERY PATHWAY'S USE OF IMMUNONUTRITION IMPACT DRINK BEFORE ELECTIVE HEPATOPANCREATICOBILIARY SURGERY
Jesse Chou*, Katherine Kramme, Sarah Khalil, Gitonga Munene
General Surgery, Western Michigan University Homer Stryker School of Medicine, Kalamazoo, MI
Background: Enhanced Recovery Protocols (ERP) have improved outcomes across multiple surgical disciplines. Additionally, perioperative immunonutrition, a key ERP component, has been associated with a shorter length of stay and favorable effect on complication rates. However, the effect of preoperative immunonutrition and ERP in HPB surgery patients remains poorly characterized.
Methods: An HPB surgery quality improvement pilot study was performed for patients undergoing pancreatic or liver surgery at a community hospital. The first group of patients constitutes a historical control of 126 patients. The ERP implemented for the experimental group of 24 patients included the same institutional protocol except for the addition of immunonutrition preoperative nutrition for the five days prior to surgery. The primary outcomes of interest included length of stay and major morbidity. Descriptive analysis consisted of Welch’s two sample t-test as appropriate. All tests were two-tailed with p < 0.05 set at statistical significance.
Results: Baseline characteristics were similar between the control and experimental groups. There was no significant difference in severity of major morbidity between liver patients (30% experimental versus 26% historical). There was no significant difference in severity of major morbidity between pancreas patients (15% experimental versus 31% historical). The experimental group had a decreased length of stay compared to the historical group (5.87 days vs. 9.59, p = 0.0003839). Among pancreas patients, the mean LOS was decreased in the experimental group (6.76 days vs. 10.18 days, p = 0.02131). Similarly, patients undergoing hepatic surgery had a decreased mean LOS (4.60 days vs. 8.98 days, p=0.004228).
Conclusion: The results demonstrate that an ERP combined with preoperative immunonutrition is associated with a significantly lower length of stay.
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