PWE-099 Audit of elective and emergency surgery for crohn’s disease at a district general hospital: is there a role for exclusive enteral nutrition and the specialist ibd dietician?

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Abstract

Introduction

Recent evidence shows that pre-operative exclusive enteral nutrition (EEN) in stricturing and penetrating Crohn’s disease is associated with better outcomes after surgery (1). We have audited our use of pre-operative EEN in Crohn’s disease patients at a large district general hospital (DGH) over a 5 year period and described outcomes in both emergency and elective admissions.

Method

We present the demographics and outcomes of adult patients with Crohn’s disease who had resections over a 5 year period (Jan 2012 to Dec 2016) at a DGH in south east England. To obtain the electronic discharge summaries we used the diagnosis and procedure codes for ‘Crohn’s disease’ and ‘Digestive Tract’ from the ICD-10 and OPCS classification of surgical operations and procedures, respectively. We reviewed whether patients were seen by a dietician in the 6 months prior to surgery or if EEN was trialled within 6 weeks of surgery.

Results

Distribution of Crohn’s disease; Small bowel 32 (39%), Crohn’s colitis 32 (39%), Ileo-colonic 18 (22%). Type of surgery; Small bowel resection 20 (24.4%), Ileo-colonic resection 24 (29.3%), Right/Left hemicolectomy 17 (20.7%), Proctectomy=5 (6.1%), Subtotal colectomy 4 (4.9%), Total colectomy 9 (11%), Panproctocolectomy 3 (3.7%).

Results

Table to compare Crohn’s patients who underwent surgical resection, divided by type of admission.

Conclusion

Only 1 in 8 patients are being treated with EEN prior to surgery at our centre. Collaboration with a specialist IBD dietician and introduction of a formal pre-operative EEN protocol will be offered to optimise patients before surgery. The ratio of elective to emergency surgery (1:1) indicates a need for a more proactive approach in preparing patients for operative intervention to reduce complications and prolonged admissions.

Disclosure of Interest

None Declared

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