SAT-143 The Effect of an Enhanced Recovery Protocol on the Length of Stay in Persons with Diabetes Requiring Colorectal Surgery

Abstract

ABSTRACT: Background: Enhanced recovery protocols (ERP) are designed to achieve early improvement post-operatively by maintaining organ function and reducing stress response. Stress stimulates the hypothalamus-pituitary-adrenal (HPA) axis resulting in marked hyperglycemia1. Previous studies have shown that patients experience better outcomes and fewer complications when they use ERP2,3. ERP utilizes a high carbohydrate load in the form of liquid shakes or juice the night before and the morning of surgery. It remains to be seen how the use of this carbohydrate load can affect outcomes in persons with diabetes. The goal of this study is to determine the effectiveness of ERP on the length of stay (LOS) in persons with diabetes requiring colorectal surgery. Methods: A retrospective chart review was performed on 74 patients with diabetes: 37 received ERP and 37 did not. The participants had their surgery between September 2012 and February 2018. Both groups were matched according to age and sex and LOS was compared as the primary outcome. Secondary variables explored were race, insurance, and benign vs. malignant pathology results. A p-value of <0.05 was considered statistically significant. Results: Majority of patients were white (76%) and male (57%) with Medicare insurance. In the group of persons with diabetes who received the ERP, the average LOS was three days (95% CL of 3.0324-5.7244) as compared to an average of eight days (95% CL of 6.6450-10.5442) in the group who did not receive ERP (p=0.0006). Older age was the only variable which correlated positively (p=0.046) and significantly with LOS; there was no difference seen amongst race, insurance or pathology results. Conclusion: This study showed that using ERP in the form of carbohydrate loading in patients with diabetes can significantly reduce LOS as compared to those who did not receive the protocol. Utilization of an ERP has the potential to improve patient outcomes, especially in persons with diabetes. The limitations of our study include that it was retrospective in design and had a small sample size. As a result, future research should include large prospective trials which would help to determine the safety and efficacy of ERP in patients with diabetes. REFERENCES: 1) Hall GM. The anesthetic modification of the endocrine and metabolic response to surgery. Ann R Coll Surg Engl. 1985;67(1):25-9. 2) Cakir H, et al. Adherence to Enhanced Recovery after Surgery and length of stay after colonic resection. Colorectal Dis. 2013:15:1019-1025. 3) Ljungqvist O, et al. Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proc Nutr Soc. 2002; 61(3): 329-336.