Abstract P2-13-12: Does the implementation of an enhanced recovery programme impact on post- operative outcomes in populations with significant comorbidity and social deprivation?

Abstract

Abstract Background: Enhanced Recovery Programmes (ERP) are a well established evidence-based model of care which are intended to reduce the impact of surgery and safely reduce the length of inpatient stay for surgical patients. In Lanarkshire, Scotland, the ERP was introduced in Wishaw General Hospital in 2012 but has yet to be extended to neighbouring Monklands Hospital. We audited the impact of the ERP by comparing post-operative outcomes between these district general hospitals in the same health board servicing adjacent catchment areas which are both in areas of significant social deprivation. Materials and Methods: All patients who underwent breast surgery from August 2012 to August 2013 inclusive were identified from a prospectively collected electronic database. Parameters analysed included ASA grades, length of postoperative stay, rate of post-operative complications and re-admissions. The relative social deprivation of patients was calculated by cross referencing their postcodes with the Scottish Index of Multiple Deprivation (SIMD) 2012. Results: 294 and 152 patients underwent 336 and 161 breast operations in Wishaw and Monklands respectively. The mean age of these patients was 57 in Wishaw and 54 in Monklands. 30% of patients in Wishaw and 19% of patients in Monklands had ASA grade 3 (range = 1 to 3, p=0.08). In both hospitals, the most common diagnosis was breast cancer (Wishaw: n=257, 76%; Monklands: n=110, 68%; p=0.17) and the most common procedure performed was wide local excision (Wishaw: n=235, 70%; Monklands: n=114, 71%; p=0.73). The mean postoperative stay was 0.9 days in Wishaw compared to 2.0 days in Monklands (p<0.001). Postoperative complications were higher in Monklands (n=37, 23%) compared to Wishaw (n=52, 15%, p=0.04). There was no significant difference in the ASA grades of patients who developed complications, rates of readmissions, A&E visits or reoperation (p>0.05). Although the Wishaw patient cohort is living in significantly more deprived areas (mean SIMD rank=2543) compared to the Monklands patient cohort (mean=2915, p=0.02), there was no significant difference in deprivation status between patients with complications in these two catchment areas (p=0.65). Conclusion: The ERP is a safe and effective protocol for breast surgery patients with low complication rates and its implementation halved the inpatient admission time in our cohort. The savings derived from this would outweigh the running costs of the ERP. Citation Format: Ee Von Woon, Adrian Wong, Juliette Murray, Alison Lannigan. Does the implementation of an enhanced recovery programme impact on post- operative outcomes in populations with significant comorbidity and social deprivation? [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-13-12.