P-298 Perioperative Oral Nutritional Support in Colorectal Cancer Patients May Improve Clinical and Health Economics Outcomes

Abstract

Introduction: Purpose of the project was to investigate the impact of high protein oral nutrition support on clinical and economics outcomes in patient with colorectal cancer. Primary Objective of the study was to assess the effect of pre- a post-operative nutritional support on frequency of complications, readmissions to hospitals and length of stay (LoS) independently of initial nutritional status of patients. Secondary Objective was to assess the impact of nutrition support on costs of treatment. Methods: Study group (SG; n 52) were adult patients with colorectal cancer (CRC) undergoing colorectal surgery. Two packs of high protein support (Nutridrink Protein, 600kcal, 40g of protein) per day were administered. Patients were instructed to use supplements 10 days (at least) before surgery (free starter pack) + 2 weeks after (prescription). Control group (CG; n 105) were the patients with the same inclusion criteria as patients in SG with conventional nutritional support. Parameters monitored - wound/anastomosis dehiscence, infections, re-hospitalization related to basic diagnosis, nutritional risk before and after surgery (protocol of TheWorking Group on Nutrition, The Czech Oncology Society), nutritional status (weight, BMI) before and 1 month after surgery, LoS, oral nutritional supplements consumption, patients palatability, benefits for the patients, costs of treatment (procedures, materials, drugs incl. antibiotics, total costs) during hospitalization and 6 months after surgery, excluding chemotherapy and radiation therapy. Results: 52 patients in SG (mean age 64) were compared to 105 patients in CG. There was significant drop in BMI after surgery (mean 24,5, s.d. 3,45, p = 0,014), before surgery (mean 25,4, s.d. 3,7) and slow-down of loss of weight after surgery (before mean 6,4%, s.d. 7,0, after surgery mean 2,6%, s.d. 5,7). 47 patients (89,8%) appraised benefits of oral nutritional supplements. SG showed 2,2x lower relative occurrence of wound dehiscence, 4,3x lower relative occurrence of anastomosis dehiscence, 2,0x lower relative occurrence of infection in wound and 1,7x lower relative risk of rehospitalization. Median LoS in SG was 8 days compare to 10 days in CG. It was approved that longer LoS means higher total costs of hospitalization in both groups of patients (p = 0,01). There were significantly lower all treatment costs in SG vs CG including costs of antibiotics during hospitalization and 6 months after surgery as well (p = 0,01). Patients without complications had significantly lower costs of drugs (p = 0,02), antibiotics (p = 0,01) vs patients with complications. Total costs per 1 day in hospital in patients in SG were 461,8 EUR (median), in CG 548,6 EUR (median). Conclusion: Pre- and post-operative intervention with high protein oral nutritional supplements reduces occurrence of post-operative complications, LoS and significantly reduces costs of treatment during hospitalization and 6 months after surgery as well in patients with CRC regardless of initial nutritional status. Oral nutritional support was well tolerated by the patients with positive appraisal of its benefits.