LB108 - PREOPERATIVE PARASYMPATHETIC AUTONOMIC DYSFUNCTION AS A PREDICTOR OF POSTOPERATIVE GASTROINTESTINAL DYSFUNCTION AFTER RADICAL CYSTECTOMY

LB108

PREOPERATIVE PARASYMPATHETIC AUTONOMIC DYSFUNCTION AS A PREDICTOR OF POSTOPERATIVE GASTROINTESTINAL DYSFUNCTION AFTER RADICAL CYSTECTOMY

A. Menon^1,2,*, N. Tetlow², A. Dewar², R. Stephens³, D. Martin^4,5, J. Whittle^3,6

¹Department of Anaesthesia, Royal Free Hospital, ²Human Physiology and Performance Laboratory (HPPL), University College London, ³Department of Anaesthesia and Perioperative Medicine, University College London Hospitals, London, ⁴University of Plymouth, ⁵Department of Intensive Care, Derriford Hospital, Plymouth, ⁶Human Physiology and Performance Laboratory (HPPL), University College London Hospitals, London, United Kingdom

Rationale: Parasympathetic autonomic dysfunction (PAD) is common in surgical patients & is a risk factor for postoperative morbidity. We hypothesised that PAD predisposes to postoperative gastrointestinal dysfunction (POGD), which is a common & serious complication after radical cystectomy (RC). We aimed to show an association between PAD & POGD following RC using I-FEED, a novel tool to identify & grade POGD.

Methods: This was a retrospective study of patients undergoing RC at University College London Hospital between 2019 & 2022. PAD was defined as heart rate recovery ≤12 beats per minute, 1 minute after cessation of loaded exercise during cardiopulmonary exercise testing. POGD was assessed using the POMS-GI & I-FEED tools. The primary outcome was POGD on day 5 after RC. Secondary outcomes assessed cardiopulmonary fitness, preoperative inflammation & survival. Ethics approval was previously granted. Statistical analysis was performed using GraphPad Prism 11.0.1 (99).

Results: 169 patients were analysed, 70% of whom had PAD. Patients with PAD were more likely to experience POGD (p=0.0329). Patients with POGD had longer length of stay (LOS) in ICU & hospital (p=0.0025, p<0.0001). Patients with impaired ventilation/perfusion matching were more likely to develop POGD (p=0.0304).

Conclusion: We believe this is the first presented use of I-FEED to describe POGD after RC. I-FEED correlated well with POMS-GI, ICU LOS & hospital LOS, suggesting that it accurately captured postoperative morbidity. PAD was more than twice as common in this cohort compared to similar previous studies. Patients with PAD had higher I-FEED scores than those without, consistent with a direct relationship. I-FEED accurately tracked POMS-GI (AUC 0.8604). I-FEED ≥4 most accurately defined POGD (overall accuracy 82.84%, Youden’s J index 0.6232). 

Disclosure of Interest: None declared