La base científica de los protocolos ERAS®

In this paper the principles of Enhanced Recovery After Surgery (ERAS) and how it is rooted in the medical sciences is reviewed and how ERAS has been developed by the ERAS Study Group and later by the ERAS®Society (www.erassociety.org). ERAS represents a formula for developing perioperative care pathways for patients undergoing surgery based on the medical literature. Expert groups review the medical literature and assembles care elements that have scientific data to show beneficial effects for recovery. By assembling multiple care elements all shown to improve outcomes, a Guideline is created from which a care pathway can be built. The Guideline is later tested in clinical practice to evaluate its effectiveness by studying compliance to the guideline care elements related to key clinical outcomes. Several ERAS®Society Guidelines have been proven to improve outcomes both with regard to complications and in hospital recovery and discharge. A growing number of reports are showing an association between improved compliance to guidelines and long term survival after surgery. Another aspect of the science behind ERAS are studies suggesting that the clinical effects are achieved by modulating various aspects of the surgical stress responses.

P5252Can functional MR imaging supersede angiography? An audit of stress cardiac MRI outcomes compared those seen in the CE-MARC trials

Background Recent studies have compared the performance of cardiac MRI (CMR) with coronary angiography. The CE-MARC trial established CMR's high diagnostic accuracy for coronary artery disease (CAD). Following these results, and those of CE-MARC 2, which showed reduced unnecessary angiography rates with CMR-guided care, we increased our adoption of CMR as an investigation of choice for CAD at our centre. Purpose In patients who have a CMR for stable angina, what is the outcome after detection of CAD, how do findings compare with angiography, and do those without CAD identified go on to have a major adverse cardiovascular event (MACE)? Method We performed a retrospective audit of all stress CMR performed from August 2016 to March 2017 at our hospital in North England. All patients were followed up for a minimum of 12 months. NICE guideline care was used during the study period. The CE-MARC trial was used for quality standards and to compare results. Results 91 stress CMRs were performed. 13 were excluded as they were performed on out-of-area patients. Median follow up was 14.5 months. Of the remaining 78 patients, 34 (43%) had a positive CMR. 20/34 (59%) proceeded to angiogram. In 16/20 of patients, CMR findings correlated with angiogram findings. A PPV of 80%. The PPV in CE-MARC was 77.2% (72.1–81.6). Of those who did not proceed to angiography, 8/14 had non-viable myocardium, 3 continued with medical management, in two it was unclear. 3/34 (8.8%) with positive CMR had a MACE. 44 patients had a negative CMR. Three had an angiogram during follow up. All were negative. There was a MACE in 1/44 (2.3%). Conclusion The audit population has a similar PPV to that of CE-MARC. MACE rates at 12 months were similar to CE-MARC which suggests that the trial results are reproducible in our setting. The wider use of CMR can therefore improve investigation and management for patients with stable angina. The audit is limited by the small number of patients proceeding to angiogram and the ability to confirm negative CMR results.

3512 Identifying Patient-Level Barriers to Non-Muscle Invasive Bladder Cancer Treatment and Surveillance Adherence in Low-Income Latino Patients: A Mixed-Methods Study

OBJECTIVES/SPECIFIC AIMS: To evaluate the determinants of non-adherence to guideline treatment and surveillance and unique barriers to care in LIU Latinos with NMIBC that will inform the development of novel patient educational materials and navigation programs that could improve adherence and thus, oncologic outcomes. METHODS/STUDY POPULATION: We will recruit 40 Latino patients with new or existing NMIBC diagnoses who present to the Urology clinic at a large, tertiary public hospital in Los Angeles from November 2018 to March 2019. Quantitative (surveys) and qualitative (semi-structured interviews) data will be collected, analyzed and integrated in order to comprehensively determine patient-level barriers to adherence. RESULTS/ANTICIPATED RESULTS: We expect to identify a unique set of patient-level barriers to adherence to NMIBC care that is unique to this population that center around 1) structural barriers to care, 2) knowledge, attitudes, and beliefs that pertain to education, acculturation, gender and values, and 3) general and disease-specific health literacy. DISCUSSION/SIGNIFICANCE OF IMPACT: The barriers to surveillance and treatment NMIBC care are significant, particularly in LIU and minority patients, which is important as non-adherence to guideline care is linked to poorer cancer outcomes. The data generated herein will inform the development of tools and programs to aid in reducing or eliminating these barriers, but also will inform discussions on the effectiveness of current clinical practices for low-income Latino patients.