eP290 - Enhanced Recovery After Surgery (ERAS) Outcomes Among Non-diabetic versus Diabetic Patients Who Underwent Elective Colorectal Surgery

Purpose/Background: Enhanced recovery after surgery is an evidence-based surgical protocol which consists of several pre-, peri- and post-operative care guidelines. It was developed in 2005 and has shifted the paradigm of both surgical and anesthetic care since its implementation. [1][2] ERAS has since been consistently shown to reduce hospital length of stay (LOS) and postoperative complications. [1] Some of the central tenets of ERAS are reduction of perioperative stress and inflammation, controlling the hypermetabolic state of surgery, maintenance of normoglycemia, and provision of nutritional support. [3][4]While ERAS has been established among non-diabetics, data regarding its application among diabetics remain limited. Most studies that implement ERAS have excluded patients with diabetes, leading to varying recommendations. [5][6] For example, there is a hypothetical risk that preoperative carbohydrate loading (a key protocol in ERAS) for diabetic patients may lead to delays in gastric emptying and thus put them at risk of aspiration pneumonia. However, not enough evidence has supported this claim. [1][6] In fact some authors suggest that ERAS may be applied to diabetics as long as their comorbidities are optimized adequately. [7]This study aims to evaluate surgical outcomes (i.e. LOS, reoperation, readmission rates, complication rates, rates of anastomotic leaks, and mortality) among non-diabetic and known diabetic patients with regard to Enhanced Recovery After Surgery (ERAS).Methods/Interventions: In this retrospective cohort study, 722 patients who underwent elective colorectal surgery under ERAS protocol were grouped into diabetes status. Patients with unknown diabetes status were excluded from the analysis. Data regarding length of stay (LOS), reoperation, anastomotic leaks, reoperation, development of complications and anastomotic leaks, and mortality were extracted from the ERAS Interactive Audit Database from 2018 to 2023. Categorical data were analyzed using Fisher’s exact test while the LOS was analyzed using t-test. Significance level was set at p = 0.05.Results/Outcomes: Five hundred seventy-seven patients did not have diabetes while one hundred eight patients had type 2 diabetes (including those on medications and those on diet). The mean hospital LOS among diabetics was statistically higher compared to that of non-diabetics (7.6±9.7 days vs 6.6±5.7 days, p = 0.045). Furthermore, complication rate was statistically higher (40%) among diabetics compared to non-diabetics (27%) (p = 0.005). Rates of anastomotic leaks, reoperation, and mortality did not different between the groups (Table 1).Conclusion/

Discussion: Among patients who underwent elective colorectal surgery under the ERAS protocol, there was no association between DM status and rates of anastomotic leak, reoperation, and mortality. However, diabetes mellitus was found to be associated with a higher LOS and complication rate compared to those without diabetes. More studies can be done to further elucidate the association and provide guidance on the application of ERAS among diabetic patients.Table 1. Outcomes of ERAS Patients with and without DMSummary table of ERAS patients comparing LOS, rates of anastomotic leaks, reoperation, complications, and mortality among DM vs non-DM patients