EP359 - Introduction of a pathway to improve post operative nutrition for patients undergoing a Whipple procedure - a closed loop audit

Abstract

Abstract Aim Adequate nutrition in the post operative phase is an essential part of recovery following pancreaticoduodenectomy. A pathway was introduced in the regional hepatobiliary unit to standardise post operative nutrition for this patient group. Methods Three audit cycles were completed by retrospective data collection following each intervention. The first cycle was completed between March and May 2023 (n=9). The nutrition pathway was then updated so patients were on the same oral pathway regardless of whether they received parenteral nutrition or not. The second cycle was completed from May-June 2023 (n=8) and a third cycle was completed from August-October 2023 (n=7) after an education session with surgical trainees by a registered dietitian. Results Day 1 of the pathway and prescribing of CREON and supplements were consistently done well. Improvements were seen in adherence to the pathway at day 2 (22%/75%/57%) and day 3 (11%/63%/43%) post op, median number of days to establishing soft diet (from 8 to 5), median day to stopping parenteral nutrition (from 9 to 6) and median length of stay reduced from 15 to 10 days. Conclusion Adhering to a post operative nutritional pathway for patients following pancreaticoduodenectomy establishes patients on oral nutrition earlier, allowing for earlier stopping of parenteral nutrition (and thus removal of central venous access) and facilitating earlier discharge from hospital. Future work will involve re-audit with a larger cohort and incorporating education on the pathway into the biannual induction to the unit for trainees.