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N. Oswald
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P1.10 - Nursing/Palliative Care/Ethics (ID 696)
- Event: WCLC 2017
- Type: Poster Session with Presenters Present
- Track: Nursing/Palliative Care/Ethics
- Presentations: 1
- Moderators:
- Coordinates: 10/16/2017, 09:30 - 16:00, Exhibit Hall (Hall B + C)
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P1.10-002 - Outcome of Pilot RCT in Lung Cancer Surgery Patients Receiving Either Preop Carbohydrate & Postop Nutritional Drinks or Water (ID 8405)
09:30 - 09:30 | Author(s): N. Oswald
- Abstract
Background:
In recent thoracic surgical studies, malnutrition and/or weight loss are important risk factors for complications after surgery. However, it is uncertain whether modifying or optimising perioperative nutritional state with oral supplements results in a reduction in complications or malnutrition. Enhanced Recovery After Surgery (ERAS) programmes in non-lung surgery include pre-surgery optimisation with carbohydrate loading drinks and post-surgery nutritional supplements. These interventions have proven highly effective in reducing post-operative complications. No trials have been performed in thoracic surgery to assess the impact.
Method:
Single centre mixed method open label Randomised Controlled Trial (RCT) was conducted to assess the feasibility of carrying out a large multicentre RCT in patients undergoing lung resection. A nutritional intervention regime of preoperative carbohydrate-loading drinks 4x200mls evening before surgery and 2X200mls the morning of surgery, and early postoperative nutritional protein supplement drinks twice a week for 2 weeks was compared to the control group receiving an equivalent volume of water. Trial feasibility measures were collected as primary outcome. Postoperative pulmonary complications were measured using the Melbourne group scale along with additional surgical complications. Visual analogue scores of symptoms, Quality of Recovery score 40, quality of life (EQ-5D-5L) and satisfaction questionnaires were collected at baseline, in hospital, 3-4 weeks and 3 month post-surgery along with hand grip and peak flow. Qualitative semi structured interviews post-surgery were undertaken to assess patient experience of the trial and interventions.
Result:
Feasibility criteria’s were met and the study completed recruitment 5 months ahead of target. All elective lung cancer surgery patients were screened of which 41% (n=64) were randomised over 6 month period. The 2 groups were well balanced and tools used to measure outcome robust. 97% of patients were compliant with nutritional drinks scheduled pre-surgery, 89% of 3 month questionnaires were returned completed. Importantly, qualitative interviews demonstrated that the trial and the intervention were acceptable to patients. Patients felt the questionnaires used captured their experience of recovery from surgery well.
Conclusion:
Current international guidelines for enhanced recovery following thoracic surgery cannot recommend pre or post-operative nutrition because of lack of evidence. We have shown an intervention and a trial design of pre-op carbohydrate-loading and post-surgery supplementation is highly acceptable to patients’ with good compliance to both intervention and trial measures. A large multi-centre clinical trial is required to test clinical efficacy in improving outcomes after surgery.
