SAT-142 Enhanced Recovery Protocol (ERP) in Patients with Diabetes: Consider It More Often

Abstract

Abstract Background: The perioperative use of Enhanced Recovery Protocol (ERP) has demonstrated improvement in the length of stay (LOS) and the rate of complications in multiple Randomized Control Trials (RCT)1. One of the components of this protocol is supplementation of carbohydrate solution (low dose: 10-44g or high dose: 45g or more) the night before and to two hours prior to the surgery. Carbohydrate rich drink as part of ERP improves glycemic control post-operatively most likely by inducing endogenous insulin release. This markedly improves the protein synthesis in first 24 hours after the surgery thereby improving muscle strength and nitrogen economy. However, most of the RCTs examining the impact of ERP have excluded the patients with diabetes2 due to concerns about an increased risk of poor outcomes. Patients with hyperglycemia are more likely to develop immunosuppression, impaired wound healing and perioperative infections3,4. Here we aim to study retrospectively the clinical outcomes of glucose supplementation in patients with diabetes compared to those without undergoing ERP for colorectal surgery. Methods: We conducted a retrospective chart review of 88 patients with diabetes and 437 patients without diabetes who used the ERP perioperatively for a colorectal surgery between September 2012 and February 2018. We performed an age and sex related cross match between 108 patients with diabetes (N=54) who received ERP to those without diabetes (N=54) who received ERP and compared the LOS as primary outcome. Data was summarized using descriptive statistics. Two-sample t-test/Wilcoxon rank sum test was used to compare the continuous variables including length of stay between diabetic and non-diabetic patients. Chi-squared/ Fisher’s exact test was used to see whether being diabetic or not was associated with other categorical variables such as gender. Results: Majority of the patients were white (83%) with private insurance (55%) and a mean age of 67.1 years. There was even distribution of males and females. There was no difference in the mean LOS of the patients with diabetes vs. those without diabetes (4.0 days [95% CI: 3.18 to 4.81 days] vs 4.03 days [95% CI: 3.09 to 4.98 days], P=0.95). Older age positively correlated with increased LOS, but race, insurance type and tumor pathology did not. Conclusions: Patients with diabetes undergoing colorectal surgery with use of an ERP protocol perioperatively have no significant difference in their length of stay as compared to those without diabetes. Although our study included only a small sample size, it supports the need to conduct an RCT that would further help to establish safety of utilization of ERP in patients with diabetes. References: (1) Liang et al. Int J Colorectal Dis (2012) 27:1549-1554 (2) Crowe PJ et al. Br J Surg 1984; 71(8): 635-637. (3) Ljungqvist et al. Proc Nutr Soc 2002; 61(3): 329-336. (4) Albalawi Z et al. World J Surg 2017; 41(8): 1927-1934.