OGC P26 The role of inadequate analgesia in care escalation after oesophagectomy

Abstract Background There is a paucity of data describing the incidence and causes escalation in level care after oesophagectomy for cancer. This study aimed to address this, including description baseline predisposing variables, contrasting profile among different surgical approaches oesophagectomy. Methods was retrospective analysis prospectively maintained database (‘CODA’) at UK tertiary centre. CODA bespoke, high-quality resource, based on senior clinician scientist entry every stage patient's pathway. Complications are updated weekly using Esophageal Consensus group definition-set. The inclusion criteria were anyone undergoing cancer between 01/06/2015 31/05/2021. Exclusion included patients not ‘Enhanced Recovery Surgery’ pathway with delayed extubation (>2 days post-operatively). Escalation defined as re-admission intensive unit (ICU) or re-intubation ICU. Standard our centre maintain epidural analgesia four surgery. Inadequate more than one reference inadequate pain control first surgery when patient deteriorated required escalation. Characteristics compared without escalation, respiratory failure related analgesia. Results From 448 oesophagectomys, 42 had their (9.38%). Baseline characteristics similar, except escalated likely have squamous cell carcinoma histology (28.6% vs 14.3%, P = 0.02). 20.0% 3-phase but this just failed achieve significance other (9.6%, 0.06). Of patients, 35.7% analgesia, 33.3% 31.0% did reason major cause pneumonia (6 14, 42.9%) most frequent non-respiratory associated re-operation (5 13, 38.5%). commonly contributing factor left thoracoabdominal all (11 18 [61.1%] 4 24 [16.7%], 0.003). Conclusions overall rate low 9.38%. figure may be useful benchmarking ongoing research into morbidity no clear influence from approach care. Respiratory contributed majority patients. Our indicates that thoraco-abdominal incisions particularly sensitive which suggests effective analgesic rescue plans especially critical type