833 CLINICAL PATHWAY DEVELOPMENT AND IMPLEMENTATION FOR THE MANAGEMENT OF CHYLE LEAK FOLLOWING OESOPHAGECTOMY: THE OXFORD EXPERIENCE

Abstract

Abstract Thoracic chyle leakage is a major and frequently encountered complication following oesophagectomy. The incidence of chyle leakage depends on the definition used and been reported to be as high as 20% among patients undergoing oesophagectomy. The sequalae can be severe and include hypovolemia, electrolyte disturbance, malnutrition, immune suppression, and increased mortality, thereby making prompt diagnosis and optimum management essential. Nevertheless, controversy remains surrounding the nature and timing of interventions. Methods Retrospective audit was performed of 227 consecutive patients undergoing oesophagectomy between October 2014 and April 2018 at the Oxford Oesophagogastric Centre. Following pathway implementation, data are being prospectively collected along with surveys of the experience and satisfaction of stakeholders. Results Chyle leak was treated in 29 (12.8%) post-operative patients. Females were over twice as likely to be treated for chyle leak (OR 2.31, P = 0.042), while age and length of operation showed no association. Chyle leak was associated with a failure to complete the ERAS pathway (P = 0.005), an increased length of stay (P = 0.0001) with the median length of stay being 4 days greater among the chyle leak group, and increased rates of readmission (P = 0.032). Conclusion Our data highlight the significant morbidity associated with thoracic chyle leakage. Upon review of best available evidence, a clinical pathway was developed for the early diagnosis and standardised management of chyle leak (Figure 1). The goal of the pathway is that patients achieve predetermined outcome within a specified time frame. Here we present our development and experience of the Oxford Oesophagogastric Chyle Leak Pathway and describe the particular challenges and interim outcomes of its implementation.