OGC SO01 - Patients undergoing major upper gastrointestinal resection admitted to an enhanced peri-operative care facility: Two years of outcomes

Abstract Background The Author's Trust has set up an Enhanced Peri-Operative Care facility (EPOC) to provide a higher level of monitoring in the immediate postoperative period, for certain patients undergoing elective major surgical procedures. Patients receive a nursing ratio of 2:1, invasive blood pressure monitoring, and epidural and peripheral vasopressor infusions if required, for one day before being discharged to the ward. This service, in carefully selected patients, can remove the need for critical care admission, which patients undergoing major upper gastrointestinal (UGI) resection previously required. We believe this to be a novel pathway in the UK for major UGI resections. Method Between November 2021 to November 2023, 170 major UGI resections (oesophagectomies and gastrectomies [including total and subtotal]) were performed. 82 of these cases (48%) were admitted to EPOC, instead of the Critical Care Department (CCD). The primary project outcome consisted of the proportion of EPOC cases being successfully discharged to the ward by the end of day one. Patients failing to meet the requirements for safe EPOC discharge were transferred to the CCD. Secondary outcomes included total admission length, need for escalation to critical care after discharge from EPOC and patient deaths. Results 78% of cases admitted to EPOC after major UGI resection were able to be discharged to the ward by the end of day one. The total admission length of these cases was 11.5 days. 4.6% of patients discharged to the ward from EPOC later developed complications and needed to be transferred to the CCD. 96% of patients were discharged home. Three patients died. Conclusion The Trust has been sending major UGI resection cases to EPOC for over two years. This is the first project looking at the combined outcomes. The first year was audited in 2022 and results were used to support pathway expansion, with an increased number of patients admitted in year two. The results support the notion that when patients are selected correctly they can be cared for safely in an EPOC setting, relieving pressure on the CCD and reducing the likelihood of cancellation due to critical care capacity, improving the efficiency of the UGI surgical service.