The Effectiveness of Ward Based High Dependency Bay (HDB) in the Early Post-Operative Management of Oesophagectomies and Gastrectomies

Ali A Warsi, Mr Dr, Alex Wilkins, Dr, Richard Berrisford, Mr, Grant Sanders, Mr, Jo Rahamim, Mr, Tim Wheatley. Derriford Hospital, Plymouth, Devon, U.K.

The early post-operative management of oesophagectomies in intensive therapy unit (ITU )is well recognised in most centres. However, we have made effective use of high dependency bays on surgical ward, with appropriate nursing and medical staff, in the early post-operative management of oesophagectomies. This has obviated the need for treating these patients in the expensive ITU setting. We aimed to analyse morbidity and mortality of oesophagectomies managed routinely on ward rather than ITU in the immediate post-operative period, in a major cancer centre for oesophago-gastric surgery.
All patients who had oesophagectomy between January 2008 and November 2009 were included in the study. Data were collected retrospectively from case notes and computerised cancer database where data was collected prospectively. Pre-operative comorbidites, investigations, type of resection, morbidity and in-patient mortality, duration of stay and final pathological stage were analysed. An estimate of cost saving was made by taking account of non-ITU post-operative care.
There were 33 oesophagectomies, 25 male and 8 females. The median age at resection was 62 years (range 44 to 85). 27 (81%) patients were managed on the dedicated Upper GI surgery ward. There was 1 planned and 5 unplanned admission to ITU- 4 was early (within 7 days) and 1 was late. These were due to need for assistance with ventilation, ionotropic support and pain control issues. The average estimated cost saving for the patients not routinely admitted to ITU was £20,000/- The median length of stay in the ITU and ward based groups were 17 and 13 days respectively. Early complication comprised of 2(6%) anastomotic leaks, 2 (6%) chyle leaks, 1 stroke, 1 DVT, 2 hospital acquired pneumonia. Late complication included 1 dumping, 2 reflux, 6 patients had dysphagia requiring endoscopic dilatation. There was 1 (3%) in hospital mortality at 12 days. There were 5 other deaths ranging from 141 days to 557 days after the operation. The morbidity and in-hospital mortality is well within the figures quoted in other studies.
Post-operative management of major operations such as oesophagectomies can be effectively and efficiently carried out on a dedicated surgical ward with HDU facilities and necessary expertise, with good outcome.

Session: Poster
Program Number: P515
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