Background To identify whether compliance with Enhanced Recovery After Surgery (ERAS) Society recommendations is associated with length of stay (LOS) in a New Zealand hospital for patients undergoing segmental colectomy in mixed acute and elective general surgery wards. Methods Consecutive elective colorectal surgeries (n = 770) between October 2012 and February 2019 were audited. Patients with non-segmental colectomies, multi-organ surgeries, LOS > 14 days, and those who died were excluded. Logistic regression was used to determine the relationship between patient demographics, compliance with ERAS guidelines, and suboptimal LOS (> 4 days). Results Analysis included 376 patients. Age, surgery prior to 2014, surgical approach, non-colorectal surgical team, operation type, and complications were significantly associated with suboptimal LOS. Non-compliance with ERAS recommendations for laparoscopy [OR 8.9, 95% CI (4.52, 19.67)], removal of indwelling catheters (IDC) [OR 3.14, 95% CI (1.85, 5.51)], use of abdominal drains [OR 4.27, 95% CI (0.99, 18.35)], and removal of PCA [OR 8.71, 95% CI (1.78, 157.27)], were associated with suboptimal LOS (univariable analysis). Multivariable analysis showed that age, surgical team, late removal of IDC, and open approach were independent predictors of suboptimal LOS. Conclusions Non-compliance with ERAS guidelines for laparoscopic approach and early removal of IDC was higher among procedures performed by non-colorectal surgery teams, and was also associated with adverse postoperative events and suboptimal LOS. This study demonstrates the importance of the surgical team’s expertise in affecting surgical outcomes, and did not find significant independent associations between most individual ERAS guidelines and suboptimal LOS once adjusting for other factors.

Background:Immunosuppression (IS) remains the main treatment for progressing skin involvement, active interstitial lung disease (ILD) and underlying inflammatory joint (IJ) or muscle disease in systemic sclerosis (SSc).Objectives:This study investigated the pattern and trends in immunosuppressive agent use in patients with early SSc diagnosed before and after 2007 to determine whether the changes in the preferred type and combination of IS, timing and predictors of administration took place over the past decade.Methods:397 SSc patients from Canadian Scleroderma Research Group (CSRG) database (183dcSSc, 214 lcSSc) who had baseline and follow-up visits within 3 years (1.8±0.8) after disease onset were included: 82% females, age at diagnosis 53±13 years, disease duration 1.6±0.8 years. Organ involvement was assessed by modified Rodnan skin score, Medsger Disease Severity Score (DSS) and CSRG definitions using bivariate, chi-squared, ANOVA, and adjusted regression analyses.Results:115 dcSSc patients (63%) and 62 lcSSc (29%) received IS, most commonly methotrexate (MTX) (72% dcSSc and 52% lcSSc), followed by mycophenylate mofetil (MMF) and cyclophosphamide (CYC). Within the patients receiving IS, monotherapy prevailed (77% dcSSc and 68% lcSSc); CYC and azathioprine were the preferred choice of IS more frequently in lcSSc compared to dcSSc (p<0.006 and p<0.02, respectively). In dcSSc, IS were predominantly prescribed at years 2 and 3 after the onset of first non-Raynaud’s phenomenon (RP) manifestation, when about half of the patients received IS. The proportion of lcSSc patients receiving IS was significantly lower and distributed more equally through the first three years. After 2007, dcSSc patients received IS more often (74% vs 50%, p=0.001), especially MTX (p=0.02) and MMF (p<0.05), and earlier (peaked at 2 years after disease onset)(Table 1).Table 1.Proportion of patients receiving immunosuppressive treatment at each year after disease onset in SSc diagnosed before and after 2007.Years after the first non-RP symptomlcSScBefore 2007After 2007Total N of pts seen at each year% receiving immune suppressivesTotal N of pts seen at each year% receiving immune suppressivesP-value113154717>0.92242182180.7723491410714>0.9dcSSc1242940430.2862512665650.00013624563540.325IS administration was associated with male gender, ILD, a-Scl-70 positivity, ACA-negativity and IJ disease in lcSSc, and with ACA-negativity and a higher mRSS in dcSSc. Multivariate logistic regression analysis showed that IS treatment could be predicted by ACA-negativity in lcSSc patients (Exp(B) 0.317, p=0.012) and younger age in dcSSc patients (Exp(B) 0.974, p=0.002).Conclusion:Over the past decade, there has been a trend to prescribe IS more often, especially MTX, and earlier in dcSSc patients. MMF has gained favour over CYC. Autoantibody status was the most consistent predictor whether a patient is likely to take IS over the course of the disease.Disclosure of Interests:Ryan Park: None declared, Tatiana Nevskaya: None declared, Murray Baron: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB