Use Of Nasogastric Tube Research Articles

Minimal Clinically Important Difference (MCID) in the Functional Status Measures in Patients with Stroke: Inverse Probability Treatment Weighting.

This study proposed to evaluate the temporal trend, define the minimal clinically important difference (MCID) for five functional status measures, and identify risk factors for reaching deterioration in the MCID. This prospective cohort study analyzed 680 patients with ischemic stroke and 151 patients with hemorrhagic stroke at six hospitals between April 2015 and October 2021. All patients completed the functional status measures before rehabilitation (baseline), and at the 12th week and 2nd year after rehabilitation. Patients in the post-acute care (PAC) group exhibited significantly larger improvements for the functional status measures compared to those in the non-PAC group (p < 0.05). Patients with hemorrhagic stroke also displayed larger improvements in the functional status measures when compared to patients with ischemic stroke. Furthermore, the improvement in MCID ranged from 0.01 to 16.18 points when comparing baseline and the 12th week after rehabilitation, but the deterioration in MCID ranged from 0.38 to 16.12 points. Simultaneously, assessing the baseline and the second year after rehabilitation, the improvement in MCID ranged from 0.01 to 18.43 points, but the deterioration in MCID ranged from 0.68 to 17.26 points. Additionally, the PAC program, age, education level, body mass index, smoking, readmission within 30 days, baseline functional status score, use of Foley catheter and nasogastric tube, as well as a history of previous stroke are significantly associated with achieving deterioration in MCID (p < 0.05). These findings suggest that if the mean change scores of the functional status measures have reached the thresholds, the change scores can be perceived by patients as clinically important.

Open versus robotic-assisted radical cystectomies: A risk analysis.

4593 Background: Radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer, but it comes with significant perioperative risk with half of patients experiencing major postoperative complications. Robot-assisted radical cystectomies (RARC) have aimed to decrease patient morbidity and have become increasingly adopted in North America. Currently, both open radical cystectomies (ORC) and RARC are frequently performed. To contribute to the existing literature using newly available data from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP), representing one of the most recent, largest multi-institutional studies, while uniquely accounting for a variety of factors including type of urinary diversion, cancer staging, and neoadjuvant chemotherapy. Methods: RC procedures performed between 2019-2020 were identified in NSQIP and the corresponding Cystectomy Targeted database. Cases in the ORC group were planned open procedures, and cases in the RARC group were robotic with intra- or extracorporeal diversions, including unplanned conversion to open cases for intention-to-treat. Chi-square and t-tests were performed to compare baseline demographics and operative parameters. Multivariate analysis was performed for outcomes including major complications, minor complications, and 30-day mortality, while adjusting for operative approach, medical comorbidities, functional status, age, race, sex, BMI, ASA-classification, preoperative labs, type of urinary diversion, pathological staging, prior pelvic surgery or radiation, need for preoperative transfusion, preoperative sepsis, emergent or elective surgery, and recent chemotherapy. Results: 4,022 RC cases were identified. Of these, 3,146 (78.2%) received planned ORC while 876 (21.8%) received RARC. Baseline demographics of the patients who received ORC versus RARC were largely similar, with no significant difference in age or medical comorbidities. RARC was associated with longer operative times and shorter hospital length of stay compared to ORC. On multivariate analysis, ORC was associated with a higher rate of 30-day mortality [OR 3.1; 95% CI 1.3-7.2; p=0.009], reintubation, cardiac arrest, superficial wound infection, bleeding requiring transfusion [OR 4.7; 95%CI 3.6 - 6.1; p&lt;0.001], prolonged postoperative nasogastric tube use, rectal injury, and ureteral fistula or urine leak compared to RARC. Conclusions: In the NSQIP database, ORC is associated with higher rates of 30- day mortality and operative complications, most notably bleeding, compared to RARC. This study is unique in the size of the cohorts compared, the timeliness of the data (2019-2020), and the ability to control for factors, such as type of urinary diversion, pathological bladder cancer staging, and use of neoadjuvant chemotherapy.

Detection of Complications Associated With Nasogastric Tube Feeding in Patients With Haemorrhagic Stroke in a Tertiary Hospital

Background: Stroke poses the greatest disease burden in hospital admission among the non communicable diseases (NCD’s). In majority of cases haemorrhagic stroke is the common neurological problem. Many of the patients develop swallowing difficulty and require nasogastric feeding for maintenance of nutrition. But this feeding can be a double-edged sword as it can lead to many complications due to various factors including errors in the feeding method, dislodgement of the tube and many other causes. Our intention was to look into this neglected part of clinical practice as this is mostly handled by internists. Objectives: To evaluate the complications of nasogastric tube feeding practice on haemorrhagic stroke patients. Materials and methods: One hundred (100) adult patients aged between 18- 70 years with haemorrhagic strokeas enrolled in the study. Haemorrhagic stroke was diagnosed by the clinical presentation, neuroimaging (CT scan/ MRI). Patients requiring nasogastric tube feeding were included in the study. They were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well. All data were be collected by using a preformed data sheet and results were presented in standard method after statistical analysis. Results: Of the 100 patients studied, most common age group for stroke was 51-60 years (53%). Male to female ratio was 2.22:1. In this study population, 70% had intracerebral haemorrhage, 24% had Sub arachnoid haemorrhage and 6% had aneurysmal haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39%). Other common indications were semi consciousness (26%), unconsciousness (22%), inability to maintain feed (10%). Around 71 % of the patients had complications from NG tube feeding. Out of them, 53% of the patients had nasal irritation where 63.15%was suffering from intracerebral haemorrhage, 31.57% and 5.26% were suffering from subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 40 % patients developed aspiration pneumonia, out of them 65.51%wasintracerebral haemorrhage, 31.03% was subarachnoid haemorrhagie ,3.44% was aneurysmal haemorrhage. 38% of the patients were developed diarrhea. Diarrhoea was reported by 66.66%, 29.62%, 3.70% in intracerebral haemorrhage, subarachnoid haemorrhagic and aneurysmal haemorrhage respectively. 53% had tube blockage, out of them intracerebral haemorrhage 71.05%, subarachnoid haemorrhage 23.68%, aneurysmal haemorrhage 2.63%. 43% of the patients had electrolyte imbalance, among them intracerebral haemorrhage 67.74% and subarachnoid haemorrhage 32.25%. Tube displacement was experienced by intracerebral haemorrhage 74.16%, subarachnoid haemorrhage 25.80% and 18% of the patients were malnourished. Conclusion: NG tube feeding is an integral part of management of stroke patients with feeding difficulties. But often it is associated with various complications which can increase the morbidities in stroke patients. J Dhaka Med Coll. 2022; 31(1) : 77-85

Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options.

Risk analysis of open vs. robotic assisted radical cystectomy.

576 Background: Radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer, but it comes with significant perioperative risk with half of patients experiencing major postoperative complications. Robot-assisted radical cystectomies (RARC) have aimed to decrease patient morbidity and have become increasingly adopted in North America. Currently, both open radical cystectomies (ORC) and RARC are frequently performed. To contribute to the existing literature using newly available data from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP), representing one of the most recent, largest multi-institutional studies, while uniquely accounting for a variety of factors including type of urinary diversion, cancer staging, and neoadjuvant chemotherapy. Methods: RC procedures performed between 2019-2020 were identified in NSQIP and the corresponding Cystectomy Targeted database. Cases in the ORC group were planned open procedures, and cases in the RARC group were robotic with intra- or extracorporeal diversions, including unplanned conversion to open cases for intention-to-treat. Chi-square and t-tests were performed to compare baseline demographics and operative parameters. Multivariate analysis was performed for outcomes including major complications, minor complications, and 30-day mortality, while adjusting for operative approach, medical comorbidities, functional status, age, race, sex, BMI, ASA-classification, preoperative labs, type of urinary diversion, pathological staging, prior pelvic surgery or radiation, need for preoperative transfusion, preoperative sepsis, emergent or elective surgery, and recent chemotherapy. Results: 4,022 RC cases were identified. Of these, 3,146 (78.2%) received planned ORC while 876 (21.8%) received RARC. Baseline demographics of the patients who received ORC versus RARC were largely similar, with no significant difference in age or medical comorbidities. RARC was associated with longer operative times and shorter hospital length of stay compared to ORC. On multivariate analysis, ORC was associated with a higher rate of 30-day mortality [OR 3.1; 95% CI 1.3-7.2; p=0.009], reintubation, cardiac arrest, superficial wound infection, bleeding requiring transfusion [OR 4.7; 95%CI 3.6 - 6.1; p&lt;0.001], prolonged postoperative nasogastric tube use, rectal injury, and ureteral fistula or urine leak compared to RARC. Conclusions: In the NSQIP database, ORC is associated with higher rates of 30-day mortality and operative complications, most notably bleeding, compared to RARC. This study is unique in the size of the cohorts compared, the timeliness of the data (2019-2020), and the ability to control for factors, such as type of urinary diversion, pathological bladder cancer staging, and use of neoadjuvant chemotherapy.

The Effects of Combined Gum-chewing and Parenteral Metoclopramide on the Duration of Postoperative Ileus After Abdominal Surgery.

Postoperative ileus remains the most common cause of prolonged hospital stay after abdominal surgery. Various agents have been tested in the treatment of postoperative ileus but no agent alone has achieved effectiveness as postoperative ileus is of multifactorial aetiology. The aim of this study was to assess the effects of combined use of gum-chewing and parenteral metoclopramide on the duration of postoperative ileus after abdominal surgery. This was a randomised controlled study of patients aged 16-65 years who underwent elective abdominal surgeries. Patients were randomised into a gum-metoclopramide (GM) group, a gum-only (G) group, a metoclopramide-only (M) group and a control (C) group. Patients in the GM group chewed gum and received intravenous metoclopramide, each 8 hourly. In G group, patients chewed only gum, whereas those in M group received only 10mg of intravenous metoclopramide, 8 hourly. To C group, 10 mL of intravenous sterile water was given 8 hourly. Patients were monitored for time to passage of first flatus or faeces. Groups were compared for the duration of postoperative ileus and duration of hospital stay using analysis of variance. Statistical significance was set at a P value of <0.05. Fifty-two out of the 105 recruited patients were eligible for analysis. The male-to-female ratio was 1:1.9 with a median age of 57.0 years (interquartile range [IQR] =16 years). Prolonged postoperative ileus occurred in 9.4% (n = 5) of the patients (GM = 2, G = 1, M = 2, C = 0; P = 0.604) and was associated with longer duration of nasogastric tube use (P = 0.028). The duration of postoperative ileus was 3 days (IQR = 2), 2.5 days (IQR = 3.3), 4 days (IQR = 1.5) and 3 days (IQR = 2) in the GM, G, M, and C groups, respectively (P = 0.317), whereas the median duration of hospital stay was 7 days (IQR = 3), shortest in G group (6.5 days, IQR = 8) and longest in M group (9 days, IQR = 3) (P = 0.143). The combined use of gum-chewing and parenteral metoclopramide had no effect on the duration of postoperative ileus following abdominal surgeries in adult surgical patients.

Medical choices regarding feeding tubes in patients with end-stage dementia in Israel: nasogastric vs. percutaneous endoscopic gastrostomy.

A previous study conducted more than 15years ago in Israel found a high overall use of tube-feeding for institutionalized end-stage dementia patients (52%) and a proportionally higher use (2:1) of naso-gastric tube (NG) over Percutaneous Endoscopic Gastrostomy (PEG) tubes for enteral feeding. This rate was markedly higher than that observed in other western countries (4.9-34%), and did not conform with clinical guidelines preferring spoon-feeding over tube-feeding for these patients, and PEG over NG for those in whom tube-feeding was initiated in long-term care. Over the past decade, the Israeli Ministry of Health conducted a policy reform to neutralize the administrative incentives presumed to be responsible for this situation. Further administrative and legislative developments followed suit. Despite these, we found no significant reduction in the prevalence of tube-feeding over spoon-feeding. However, we did observe a reduction in the proportional use of NG over PEG.

Complications Associated with Nasogastric Tube Feeding among Stroke Patients at a Tertiary Hospital in Dhaka City

Background: Many stroke patients develop swallowing difficulty and require nasogastric feeding for the maintenance of nutrition.&#x0D; Objectives: The purpose of the present study was to evaluate the complications of nasogastric tube feeding practice on stroke patients.&#x0D; Methodology: This cross-sectional study was conducted from April 2014 to September 2014 in the Department of Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh. Adult patients aged between 18 to 70 years with stroke was enrolled in the study. The diagnosis of stroke was established by the clinical presentation and neuroimaging. Patients requiring nasogastric tube feeding was included in the study and were systematically examined for any complications related to use of nasogastric tube. Their caregivers were also thoroughly interviewed using a standard pre formed questionnaire regarding any complications as well.&#x0D; Results: Of the 100 patients studied, most common age group for stroke was 51 to 60 years (53.0%). Male to female ratio was 2.22:1. In this study population, 63.0% patients had ischaemic stroke; 26.0% had haemorrhagic stroke; 9.0% population had subarachnoid haemorrhage. The most common indication for NG feeding was difficulty in swallowing (39.0%). Other common indications were semi-consciousness (26%), unconsciousness (22.0%), inability to maintain feed (10.0%). Around 71.0% of the patients had complications from NG tube feeding. Out of them, 53.0% of the patients had nasal irritation, 40.0% patients developed aspiration pneumonia. 38.0% of the patients developed diarrhea, 53.0% had tube blockage. 43.0% of the patients had electrolyte imbalance and tube displacement, 18.0% of the patients were malnourished.&#x0D; Conclusion: In conclusion nasogastric tube feeding is associated with various complications which can increase the morbidities in stroke patients.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):136-142

Kritički osvrt na koncept ubrzanog oporavka nakon operacije u vaskularnoj hirurgiji - ERAS protokol u vaskularnoj hirurgiji

The concept of enhanced recovery after surgery (Enhanced Recovery After Surgery-ERAS) represents a multimodal approach to surgical treatment of patients, based on evidence, starting preoperatively and continuing postoperatively. The concept aims to improve patient recovery while reducing complications and reducing length of hospital stay. The ERAS concept has become the standard of care in colorectal surgery. It is also used in vascular surgery, especially aortic and carotid surgery. In 2022, the Society for Vascular Surgery and the ERAS Society published the latest recommendations for vascular surgery for patients undergoing open aortic surgery. The study included 590 abstracts. The recommendations refer to the period before the admission of the patient, as well as to the preoperative, intraoperative and postoperative period. Among the most important recommendations are the introduction of preoperative patient education, screening of anemia and nutritional status, optimization of risk factors, reduction of the use of nasogastric tubes and drainage, use of multimodal analgesia, targeted replacement of fluid, early removal of urinary catheters, active and early mobilization, and early enteral nutrition. There is more and more evidence about the importance of the ERAS protocol in elective vascular surgery, as well as its impact on reducing the length of hospital stay, reducing complications and better recovery of patients, lower treatment costs. Its application depends on the medical staff, so the education of healthcare workers is needed in this field.

Effect of Nasogastric Tube Placement, Manipulation, and Fluid Administration on Transcutaneous Ultrasound Visualization and Assessment of Stomach Position in Healthy Unfed and Fed Horses.

Knowledge of the effects of feeding and nasogastric tube placement and manipulation on gastric ultrasound is limited. Given the variability in duration since feeding and the ubiquitous use of nasogastric tubes in horses with colic, the interpretation of gastric ultrasound in horses with colic requires an understanding of these effects. Cranial to caudal and dorsal to ventral ultrasonographic dimensions of the stomach were obtained in 10 unfed horses and five fed horses, before and after nasogastric tube placement, after checking for reflux and after administration of 6 L of water in unfed horses. Fed horses' stomachs were larger in both cranial to caudal and dorsal to ventral dimension than unfed horses. Nasogastric intubation and the administration of water increased ultrasonographic gastric dimensions in fed and unfed horses. Checking for reflux did not consistently decrease ultrasonographic gastric dimension in fed or unfed horses. Fluid was consistently identified in the stomach with ultrasound after 6 L of water. Increases in gastric ultrasound dimensions found in horses that have been recently fed and/or had a nasogastric tube placed can occur without pathologic gastric distension related to colic and should be interpreted in this context. In contrast, the identification of fluid in the stomach on ultrasound occurs consistently with fluid administration and may be more useful than standard ultrasound parameters of gastric dimensions to identify horses with colic likely to have significant gastric reflux.

Should nasogastric tube be used routinely in patients undergoing cardiac surgery? A narrative review.

Nasogastric tube (NGT) use has been common in the immediate postoperative period in surgical patients for decades. Potential advantages include the decompression of gastric contents and the early administration of time-sensitive medications. However, its routine use after cardiac surgery has not been established as a gold standard yet. The NGT use for prevention of postoperative nausea and vomiting has been a matter of debate in literature. Also, NGT use has also been associated with the incidence of some respiratory and gastrointestinal complications and it may be a source of significant pain and discomfort to patients. In this article, we review the current available literature regarding the use of NGT during and immediately after cardiac surgery, with particular emphasis on its potential role in enhanced postoperative recovery. We performed a database search in October 2021 using Embase, Cochrane Library, and Medline to identify studies that examined the use of NGT in patients that underwent cardiac surgery. Data and literature about NGT's impact on post-operative nausea and vomiting, early administration of medications, interference with imaging, post-operative complications, respiratory complications, gastrointestinal complications, pain and discomfort, and enhanced recovery after surgery were examined. Three reports investigating the use of NGT to reduce post-operative nausea and vomiting were examined with sample sizes of 114, 104, and 202. The use of NGT did not significantly reduce the incidence of post-operative nausea and vomiting in 2/3 of the studies: a 2% nausea reduction with NGT (p < 0.05), a 7.7% nausea reduction with NGT (p = 0.6), and a 14% vomiting reduction with NGT (p = 0.007). The prevalence of pneumonia following NGT use has been shown to vary ranging from 4 to 95% with associated mortality rates of 17 to 62%. Based on our findings, there is currently not sufficient evidence to support the routine use of NGT during cardiac surgery. Further research is needed to establish the role of NGT in this patient population.

Narrow-field supracricoid partial laryngectomy: Procedure development and initial clinical experiences

ObjectivesTo evaluate the feasibility of narrow-field supracricoid partial laryngectomy with cricohyoidoepiglottopexy (NF-SCPL-CHEP). MethodsBetween 2019 and 2020, five patients with glottic cancers underwent NF-SCPL-CHEP. The mean durations of surgical drains, tracheostomy canula, and nasogastric tube use were evaluated. Length of stay following NF-SCPL-CHEP was compared with that of our open SCPL historical controls. A case summary is provided for the first patients, with detailed information about postoperative management and function. ResultsAll five patients achieved uneventful postoperative recoveries without major complications. The average time for surgical drains, tracheostomy canula, and nasogastric tube use were 2, 15, and 46 days, respectively. The mean overall hospitalization period was 36 days for NF-SCPL-CHEP patients. The mean period of hospitalization based on our early experiences between 1997 and 2005 with classical open SCPL was 72 days. All patients were fully functional and local recurrences or distant metastases were not encountered during a mean observation period of 39 months. ConclusionsNF-SCPL-CHEP with 6 cm cervical access appeared technically feasible and oncologically sound in this initial clinical experience. An extra 2 cm incision, which enabled lateral neck dissection, was not felt to detract from the overall minimally invasive basis of NF-SCPL-CHEP. The clinical results were encouraging with limited complications and predictable postoperative recovery. The length of stay for patients undergoing NF-SCPL was half that of open SCPL historical controls. Less damages to local circulation may associate with the positive influences. Further study with a large patient sample across multiple institutions are needed to carefully evaluate long-term functional and oncological outcomes.

Incidence, Associated Factors, and Outcome of Delirium among Patients Admitted to ICUs in Oman.

Background The incidence of delirium is high up to 46.3% among patients admitted to ICU. Delirium is linked to negative patient outcomes like increased duration of mechanical ventilation use, prolonged ICU stay, increased mortality rate, and healthcare costs. Despite the importance of delirium and its consequences that are significant, there is a scarcity of studies which explored delirium in Oman. Objectives This study was conducted to assess the incidence of delirium, the association between the selected predisposing factors and precipitating factors with delirium, determine the predicators of delirium, and evaluate its impacts on ICU mortality and ICU length of stay among ICU patients in Oman. Methods A multicenter prospective observational design was used. A total of 153 patients were assessed two-times a day by bedside ICU nurses through the Intensive Care Delirium Screening Checklist (ICDSC). Results The results revealed that the delirium incidence was 26.1%. Regression analysis showed that sepsis, metabolic acidosis, nasogastric tube use, and APACHE II score were independent predictors for delirium among ICU patients in Oman and delirium had significant impacts on ICU length of stay and mortality rate. Conclusion Delirium is common among ICU patients and it is associated with negative consequences. Multidisciplinary prevention strategies should be implemented to identify and treat the modifiable risk factors.

257. DIFFERENCES IN PERIOPERATIVE STRATEGIES IN ESOPHAGEAL CANCER TREATMENT IN 13 NORDIC UNIVERSITY HOSPITALS CALL FOR HIGH-LEVEL EVIDENCE REGARDING THESE PRACTICES

Abstract The Nordic countries have similar health care systems and registries simplifying epidemiological research and the treatment of esophageal cancer is largely centralized. However, differences in treatment traditions can hamper the possibility to assess results and harmonize control arms in joint randomized trials. In setting up a Nordic multi-center randomized trial regarding the use of nasogastric tube (NG-tube) decompression, we aimed to investigate differences in perioperative routines after esophageal resection at Nordic University hospitals. All Nordic University Hospitals with an upper gastrointestinal cancer center (UGC) were contacted regarding a Nordic randomized controlled trial exploring the effects and complications associated with the use of NG-tube after esophagectomy for cancer. Those who chose to join the trial were sent a questionnaire regarding surgical volumes and practices including mean annual number of esophagectomies, surgical method/access, and routine use of pyloric drainage and jejunostomy. In addition, the current standard postoperative use of NG-tube and routine X-ray/CT evaluation, along with postoperative traditions regarding the start of liquid diet was enquired. High volume centers were defined as performing &amp;gt;20 procedures/year. Thirteen of 17 centers with a combined catchment area of 16 million inhabitants and an annual volume of 445 esophagectomies joined the trial network. All, but one center used a total minimally invasive- or hybrid surgical approach but otherwise, the routine use of pyloric drainage and jejunostomy varied widely without being statistically different. All 13 centers reported routine use of NG-tube and 4 employed continuous suction. The NG-tube was removed between 3 and 7 days postoperatively, but also strategies between the centers (suction on NG-tube, start of liquid diet, routine X-ray/CT evaluation) varied without being statistically significant Firm adherence to standardized operations and safety protocols are implemented in Nordic UGCs to reduce the potential consequences of complications. However, the results find the differences in perioperative care after esophagectomy apparent, highlighting the need for high-level evidence regarding these practices. A unified approach may facilitate clinical trial initiatives. There is a paucity of evidence regarding optimal NG-tube use after esophagectomy for cancer and a randomized trial (kiNETiC ISRCTN39935085) investigating this issue is underway.

273. EVALUATION OF THE RESULTS OF ‘TUBELESS’ ESOPHAGECTOMY IN PATIENTS WITH ESOPHAGEAL CANCER WITHIN AN ERAS PROTOCOL

Abstract Classically, esophagectomy used to routinely left chest drains, as well as decompressive nasogastric tube (NGT) and feeding jejunostomy, making the postoperative period slower and more uncomfortable for patients. Our objective is to evaluate the results of not using tubes and drains (tubeless esophagectomy) in patients with esophageal cancer undergoing McKeown esophagectomy within an ERAS protocol in our center. Retrospective, descriptive and comparative study of two consecutive groups undergoing McKeown esophagectomy. The first group (P) included 25 patients with tubes and drains (April 2018–August 2019) and the second group (T) 25 patients undergoing tubeless esophagectomy (July 2020–December 2021). In group P all patients were left with thoracic drainage and jejunostomy and in selected cases abdominal drainage; no patient was left with NGT. In group T (‘TUBELESS’) no drains or NGT were placed. No jejunostomy was performed except in those patients at high risk of malnutrition, and a phantom jejunostomy was used instead. Both study groups are comparable in terms of epidemiological characteristics, etiology, preoperative tumor stage and neoadjuvant treatment. In group P, 86% of the patients underwent or already had a jejunostomy, 100% of the patients were left with a left thoracic drain and 28% with an abdominal drain. None of the patients had a cervical drain or NGT. In group T no cervical, abdominal or thoracic drain was placed, but 2 patients (8%) underwent a jejunostomy due to high risk of malnutrition. Table 1 shows the postoperative results. There are no significant differences in 90-day mortality, readmission rate or anastomotic leakage. Despite the widespread thought of the need for the use of chest drains after esophagectomy, abstention from their use, as well as abstention from the use of decompressive nasogastric tube and feeding jejunostomy (replacing it with the use of a ghost jejunostomy), does not increase morbimortality and improves the postoperative comfort of the patient, as well as the hospital stay.

Entrapment of a long dwelling nasogastric tube after radiotherapy in an oral cancer patient: a rare case report

The use of a nasogastric (NG) tube forms a part of the daily routine after surgery for oral cancer, and is vital for enteral feeding of the patient. However, the use of NG tubes is not without complications, which include tube obstruction, tube breakage, tube double backing, and kinking. NG entrapment, which is seen in bariatric and other gastrointestinal surgeries when the tube is caught in the staple line, is rarely seen in postoperative patients with oral cancer due to the long dwelling of the tube and the adjuvant radiotherapy. A 55-year-old man presented after 3 months of surgery for oral cancer and having completed adjuvant radiotherapy with a blocked and stuck nasogastric tube. After the endoscopic removal of the tube failed twice, the NG tube was removed by performing a gastrostomy via the midline mini laparotomy approach. Frequent monitoring, changing of NG tube and continual re-review of indications for continued use of feeding tubes is prudent, including consideration of changing goals of care. Educating the patient and his relatives/care takers at the time of the discharge with the instructions of care will surely help to prevent such a complication.

Development of a Delirium Risk Predication Model among ICU Patients in Oman.

Background Delirium is a common disorder among patients admitted to intensive care units. Identification of the predicators of delirium is very important to improve the patient's quality of life. Methods This study was conducted in a prospective observational design to build a predictive model for delirium among ICU patients in Oman. A sample of 153 adult ICU patients from two main hospitals participated in the study. The Intensive Care Delirium Screening Checklist (ICDSC) was used to assess the participants for delirium twice daily. Result The results showed that the incidence of delirium was 26.1%. Multiple logistic regression analysis showed that sepsis (odds ratio (OR) = 9.77; 95% confidence interval (CI) = 1.91–49.92; P < 0.006), metabolic acidosis (odds ratio (OR) = 3.45; 95% confidence interval [CI] = 1.18–10.09; P=0.024), nasogastric tube use (odds ratio (OR) 9.74; 95% confidence interval (CI) = 3.48–27.30; P ≤ 0.001), and APACHEII score (OR = 1.22; 95% CI = 1.09–1.37; P ≤ 0.001) were predictors of delirium among ICU patients in Oman (R2=0.519, adjusted R2=0.519, P ≤ 0.001). Conclusion To prevent delirium in Omani hospitals, it is necessary to work on correcting those predictors and identifying other factors that had effects on delirium development. Designing of a prediction model may help on early delirium detection and implementation of preventative measures.

State of the art of enhanced recovery after surgery (ERAS) protocols in esophagogastric cancer surgery: the Western experience.

Enhanced recovery after surgery (ERAS) programs provide a framework to standardize care processes and improve outcomes. The results of this multimodal and multidisciplinary approach based on actions focused on reducing physiological surgical stress in the preoperative, intraoperative, and postoperative periods are beneficial in reducing morbidity and hospital stay, without increasing readmissions across different surgical settings. The implementation of ERAS in resection procedures of esophageal and gastric cancer has been challenging due to the complexity of these surgical techniques and the high risk of complications. Despite the limited evidence of ERAS in esophagectomy operations, systematic reviews and meta-analysis have confirmed a reduction of pulmonary complications and hospital stay without increasing readmissions. In gastrectomy operations, the implementation of ERAS reduces the use of nasogastric tubes and intraabdominal drains, facilitates early diet, and reduces the length of hospital stay, without increasing complications. There is, however, wide heterogeneity and absence of standardization in the number and definition of the ERAS components. The development of ERAS consensus guidelines including procedure-specific components may reduce this variability. Regardless growing evidence of the effectiveness of ERAS, the adherence rate is still low. The commitment of the multidisciplinary team and leadership is critical in the application and refinement of ERAS protocols in parallel with periodic audits. Pre- and post-habilitation methods are emerging concepts to be incorporated in ERAS protocols.

Retropharyngeal lymph node dissection in head and neck cancers treated with transoral robotic surgery

Objective: To evaluate the indications, safety, feasibility, and surgical technique for patients with head and neck cancers undergoing transoral robotic retropharyngeal lymph node (RPLN) dissection. Methods: The current study enrolled 12 consecutive head and neck cancer patients (seven males and four females) who underwent transoral robotic RPLN dissection with the da Vinci surgical robotic system at the Sun Yat-sen University Cancer Center from May 2019 to July 2020. Seven patients were diagnosed as nasopharyngeal carcinoma with RPLN metastasis after initial treatments, 4 patients were diagnosed as thyroid carcinoma with RPLN metastasis after initial treatments, and one patient was diagnosed as oropharyngeal carcinoma with RPLN metastasis before initial treatments. The operation procedure and duration time, intraoperative blood loss volume and complications, nasogastric feeding tube dependence, tracheostomy dependence, postoperative complications, and hospitalization time were recorded and analyzed. Results: All patients were successfully treated by transoral robotic dissection of the metastatic RPLNs, none of which was converted to open surgery. RPLNs were completely resected in 10 patients, and partly resected in 2 patients (both were nasopharyngeal carcinoma patients). The mean number of RPLN dissected was 1.7. The operation duration time and intraoperative blood loss volume were (191.3±101.1) min and (150.0±86.6) ml, respectively. There was no severe intraoperative complication such as massive haemorrhage or adjacent organ injury during surgery. Nasogastric tube use was required in all patients with (17.1±10.6) days of dependence, while tracheotomy was performed in 8 patients with (11.6±10.7) days of dependence. The postoperative hospitalization stay was (8.5±5.7) days. Postoperative complications occurred in 4 patients, including 2 of retropharyngeal incision and 2 of dysphagia. During a follow-up of (6.5±5.1) months, disease-free progression was observed in all patients, 10 patients were disease-free survival and other 2 patients were survival with tumor burden. Conclusions: The transoral robotic RPLN dissection is safety and feasible. Compared with the traditional open surgical approach, it is less traumatic and safer, has fewer complications and good clinical application potentiality. The indications for transoral robotic RPLN dissection include thyroid carcinoma, oropharyngeal carcinoma, and some selected nasopharyngeal carcinoma and other head and neck cancers. Metastatic RPLNs from some nasopharyngeal carcinoma with incomplete capsule, unclear border and adhesion to the surrounding vessels are not suitable for transoral robotic RPLN dissection.

104: PERIOPERATIVE STRATEGIES IN ESOPHAGEAL CANCER RESECTION IN 12 NORDIC UNIVERSITY HOSPITALS

Abstract Background and aim The Nordic countries have similar health care systems and registries simplifying epidemiological research. Differences in treatment traditions can, however, hamper the possibility to assess results and to harmonize control arms in joint randomized trials. In the process to set up a Nordic multi-center randomized trial regarding use of nasogastric tube (NG-tube) decompression after esophagectomy, we aimed to investigate perioperative routines in 12 University Hospitals in Sweden, Denmark, Norway and Finland. Methods All Nordic University Hospitals were contacted regarding a Nordic randomized controlled trial exploring effects and complications associated with the use of nasogastric tube use after esophagectomy for cancer. Those who chose to join the trial were sent a questionnaire regarding surgical and perioperative routines. Results Twelve centers with a combined catchment area of 16 million inhabitants and an annual volume of 400 esophagectomies joined the trial network. All but one used totally minimally invasive or hybrid surgical approach. All 12 centers reported routine use of NG-tube and 5 employed continuous suction. The NG-tube was removed between 3 and 7 days postoperatively. A routine pylorus drainage procedure was reported from two centers. Jejunostomy was used universally in 5 centers and selectively in 6 centers. One center did not use jejunostomy. Conclusion Differences in perioperative care after esophagectomy is apparent in the Nordic countries, highlighting the need for high-level evidence regarding these practices. A unified approach may facilitate clinical trial initiatives. There is a paucity of evidence regarding optimal NG-tube use after esophagectomy for cancer and a randomized trial investigating this issue is under way.