CRP levels are higher after open surgery compared with laparoscopic surgery, both with and without AL. AL generates a significant detectable increase in CRP within 2-4 days after surgery.

IntroductionIncreasing pressure and limitations on the NHS necessitate simple and effective ways for maintaining standards of patient care. This quality improvement project aims to design and implement user-friendly and clear ward round stickers as an adjunct to surgical ward rounds to evidence standardised care.Project design and strategyBaseline performance was measured against the recommended standards by the Royal College of Physicians, General Medical Council and a study performed at the Imperial College London. A total of 16 items were studied. All members of staff in surgery department were informed that an audit on ward round entries would be implemented but exact dates and times were not revealed. In the first cycle, ward round sticker was implemented and results collected across three random days for use and non-use of sticker. Feedback was collected through the use of questionnaires. In the second cycle, the ward round sticker was redesigned based on feedback and results collected for use and non-use of sticker.ResultsBaseline performance noted in 109 ward round entries showed that checking of drug chart, intravenous fluid chart, analgesia, antiemetic, enoxaparin, thromboembolic deterrents ranged from 0% to 6%. With the introduction of ward round stickers in both cycles, there was noticeable improvement from baseline in all items; in ward round entries where stickers were not used, performance was similar to baseline.ConclusionThis quality improvement project showed that the use of stickers as an adjunct to surgical ward round is a simple and effective way of evidencing good practice against recommended standards. Constant efforts need to be made to promote compliance and sustainability. Commitment from all levels of staff are paramount in ensuring standardised patient care without overlooking basic aspects.

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The aim of this study was to evaluate the feasibility of Enhanced Recovery After Surgery (ERAS) protocol in high-risk patients undergoing colorectal surgery, and to analyze the influence of clinical and demographic features on efficacy of a multimodal rehabilitation.

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Objectives: Patient outcomes are maximised in the enhanced recovery setting although the sexual function outcomes of patients undergoing laparoscopic extra-levator abdomino-perineal resection (ELAPR) performed in the enhanced recovery after surgery (ERAS) setting are currently not fully explored. This study aimed to identify objectively the short-term outcomes of these patients. Methods: Data for this observational study were collected retrospectively from consecutive male patients undergoing ELAPR. Basic demographic data, neo-adjuvant therapy, operative details, complications and International Index of Erectile Function (IIEF-5) scores were recorded pre and post procedure. Results: In total 14 patients underwent consecutive ELAPR. Median age was 67 years (range 54-86). 7 patients received neo-adjuvant pelvic radiotherapy. Median follow-up was 21 months (range 8-50). IIEF scores were globally reduced after surgery for each domain: erectile dysfunction (18.4 vs. 8.9, p¼0.028, mild-to-moderate to moderate dysfunction), orgasmic function (7.9 vs. 4.0, p¼0.01, mild to moderate dysfunction), sexual desire (6.6 vs. 4.9, p¼0.076, mild-to-moderate to moderate dysfunction), intercourse satisfaction (9.3 vs. 4.5, p<0.035, mild-to-moderate to moderate dysfunction), overall satisfaction (7.6 vs. 4.1, p<0.005, mild to moderate dysfunction). IIEF scores were lower after surgery in patients receiving neo-adjuvant therapy (mean reduction in domain score 6.65 vs. 2.6, p¼0.08). Erectile dysfunction was significantly worse after ELAPR following neo-adjuvant treatment (mild-to-moderate to severe dysfunction, p¼0.01), compared with ELAPR alone (mild-to-moderate dysfunction unchanged, p¼0.43). Conclusion: ELAPR significantly worsens male sexual function in the short term, exacerbated by neo-adjuvant chemo-radiation. In the ERAS setting, other factors such as surgeon's experience and technique, treatment modalities and pre-and post-procedure psychosocial factors should be explored in future studies to improve outcomes. Disclosure of interest: None declared. Scale range¼18-126. Results are mean difference (95% CI), unless specified. *Hypothesis supported Abstracts / Clinical Nutrition ESPEN 12 (2016) e30ee59 e45