P-P24 Optimising post-operative nutrition in patients undergoing pancreaticoduodenectomy

Background A considerable number of patients undergoing pancreaticoduodenectomy require supplemental nutrition in the postoperative period. However, there remains no national consensus on the optimal postoperative supplemental feeding modality. Furthermore, at our institution a variation in practice exists when considering post-operative entera (via the naso-jejunal (NJ)) or parenteral nutrition (PN). This study aimed to evaluate the utility of post-operative enteral or parenteral nutrition at our centre and to explore risk factors predisposing patients to post-operative nutritional deficits requiring supplementation. Methods We retrospectively analysed the electronic case records of all patients undergoing a pancreaticoduodenectomy between November 2019 and November 2020 at our HPB specialist centre. Key patient demographic data and post-operative nutritional requirements with route, length and indication for supplemental feeding as well as biochemical markers, length of stay (LoS) and complications were collected and analysed. Data were analysed via intention to treat analysis. Results 48 patients underwent a pancreaticoduodenectomy, of which 26 had an NJ tube inserted intra-operatively. 16 (33%) patients required supplemental feeding, via NJ route in 7 and PN in 9. 2 patients were intolerant to NJ feeds and progressed to PN. NJ fed patients had shorter LoS (12(10-42) vs. 28(14-63) days)(p = 0.09) compared to PN feeding. PN-related line infection or thrombosis in 4 (36%) patients. Supplemental feeding met daily kcal requirements in 13 (81%) patients, but PN was associated with greater weight loss (-5%) than NJ feeding (-3%). Significantly increasing the risk of needing supplemental nutrition: advanced age(p = 0.04), ASA≥2(p = 0.04) and anastomotic leak(p = 0.02). Conclusions In this group of patients, NJ feeding was largely well-tolerated and the majority of patients met their required daily kcal via this route. Due to the increased incidence of complications associated with PN, NJ feeding should be considered as the 1st line option for post-operative nutritional supplementation, with intra-operative insertion of an NJ tube considered for higher-risk patients.

Women, Infants, and Children Cash Value Benefit Redemption Choices in the Electronic Benefit Transfer Era

Purpose This study aims to examine the relationship between cash value benefit (CVB) redemption outcomes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) across food processing types and socio-demographics. Design Cross-sectional and panel analyses. Setting Virginia. Subjects 98,067 Virginia WIC households. Measures CVB redemption rate. Results The predominant share of CVB redemption was for fresh produce (77.3%). Non-Hispanic whites and blacks redeemed a smaller share of fresh produce than Hispanic participants ( P < .001). Non-Hispanic black WIC households have a significantly lower CVB redemption rate than non-Hispanic white WIC households (β = −.008, P < .001). Households with a child participant tend to have a higher redemption rate (β = .01, P < .001). The redemption rates of fruits and of vegetables were positively correlated with household size. Conclusions Minority status and household size were significantly related to CVB redemptions among Virginia WIC participants.