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Coutinho RB, Peres WAF, de Paula TP. Association between preoperative fasting time and clinical outcomes in surgical patients in a private general hospital. Acta Cir Bras 2024; 39:e394524. [PMID: 39166554 PMCID: PMC11328893 DOI: 10.1590/acb394524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 06/08/2024] [Indexed: 08/23/2024] Open
Abstract
PURPOSE Surgical patients are routinely subjected to long periods of fasting, a practice that can exacerbate the metabolic response to trauma and impair postoperative recovery. The aim of this study was to evaluate the association between preoperative fasting time and clinical outcomes in surgical patients. METHODS An observational, prospective study with a non-probabilistic sample that included patients of both sexes, aged over 18, undergoing elective surgeries. Data were extracted from electronic medical records, and a questionnaire was applied in 48 hours after surgery. Variables related to postoperative discomfort were assessed using an 11-point numeric rating scale. RESULTS The sample consisted of 372 patients, and the duration of the surgical event ranged from 30-680 minutes. The incidence of nausea (26.34%) was twice that of vomiting (13.17%) and showed an association with the surgical procedure's size (p = 0.018). A statistically significant difference was observed only between pain intensity and preoperative fasting times for liquids (p = 0.007) and postoperative fasting time (p = 0.08). The occurrence of postoperative complications showed no association with preoperative fasting time (p = 0.850). CONCLUSIONS Although no association was observed between preoperative fasting time and surgical complications, it is noteworthy that both recommended and actual fasting time exceeded the proposed on clinical guidelines.
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Affiliation(s)
- Rafaela Batista Coutinho
- Universidade Federal do Rio de Janeiro – Instituto de Nutrição Josué de Castro – Departamento de Nutrição e Dietética – Rio de Janeiro (RJ) – Brazil
| | - Wilza Arantes Ferreira Peres
- Universidade Federal do Rio de Janeiro – Instituto de Nutrição Josué de Castro – Departamento de Nutrição e Dietética – Rio de Janeiro (RJ) – Brazil
| | - Tatiana Pereira de Paula
- Universidade Federal do Rio de Janeiro – Instituto de Nutrição Josué de Castro – Departamento de Nutrição e Dietética – Rio de Janeiro (RJ) – Brazil
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Gregori P, Franceschetti E, Basciani S, Impieri L, Zampogna B, Matano A, Manzi C, Carbone L, Marano L, Papalia R. Immunonutrition in Orthopedic and Traumatic Patients. Nutrients 2023; 15:nu15030537. [PMID: 36771245 PMCID: PMC9919811 DOI: 10.3390/nu15030537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023] Open
Abstract
The role of nutrition intervention in surgical settings is constantly developing and evolving. Immunonutrition represents a viable option to reduce perioperative and postoperative complications in surgical oncology. However, as far as we know, little research has been conducted in the orthopedic field. With this review, we aim to summarize the state of the art in the application of immune-enhanced compounds to surgical, orthopedic, and traumatic patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adopted. A comprehensive search was carried out using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies dealing with immunonutrition fed to traumatic and orthopedic patients were pooled, the data were extracted, and the studies were discussed. A total of eight studies were included: six focused on trauma surgery and two on elective orthopedic surgery. The epidemiological characteristics of participants and the assessment of results were reported. Data were analyzed using R software (2020; R Core Team). Based on the current available literature, a positive impact of immunonutrition in orthopedic and trauma surgical settings was registered. All studies analyzed showed the favorable impact of the immunonutrition diet on clinical outcomes. The full effect of this type of nutrition and its different applications in the orthopedic and traumatic fields should be critically investigated through more extensive randomized controlled trials.
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Affiliation(s)
- Pietro Gregori
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Edoardo Franceschetti
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Susanna Basciani
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Lorenzo Impieri
- Residency Program in Orthopedics and Traumatology, University of Milan, 20122 Milan, Italy
| | - Biagio Zampogna
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
| | - Alfredo Matano
- Health Service Management Board, Azienda Ospedaliera di Caserta Sant’Anna e San Sebastiano, 81100 Caserta, Italy
| | - Carlo Manzi
- Health Service Management Board, Azienda Sanitaria Locale Caserta, 81100 Caserta, Italy
| | - Ludovico Carbone
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Luigi Marano
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
- Correspondence:
| | - Rocco Papalia
- Department of Orthopedic and Trauma Surgery, Campus Bio-Medico University, 00128 Rome, Italy
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Effect of Muscle Loss but Not Fat Loss during Primary Debulking Surgery and Chemotherapy on Prognosis of Patients with Ovarian Cancer. J Clin Med 2022; 11:jcm11113184. [PMID: 35683568 PMCID: PMC9181028 DOI: 10.3390/jcm11113184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023] Open
Abstract
Although the negative effect of muscle loss during invasive treatment has been widely reported in patients with cancer, its value in patients with ovarian cancer is not clear. Therefore, this study was conducted to clarify whether muscle loss during cytoreductive surgery and chemotherapy affects prognosis in patients with ovarian cancer. We retrospectively recruited 58 patients with ovarian cancer who underwent site reductive surgery and chemotherapy at Shimane University Hospital from March 2006 to November 2013 and for whom pre- and postoperative computed tomography were available. Skeletal muscle changes and fat mass volume during primary debulking surgery and chemotherapy were subsequently investigated at the level of the third lumbar vertebra. Muscle and fat mass loss occurred independently in half of the patients. Muscle loss, but not fat loss, was associated with disease-free survival (p = 0.041 and p = 0.794, respectively) and poor overall survival (p = 0.033 and p = 0.61, respectively). Cancer therapy is invasive and causes compositional changes in the body, such as muscle and fat loss. During cancer therapy, muscle loss, but not fat loss, may be associated with worse prognosis in ovarian cancer.
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Gonçalves TJM, Gonçalves SEAB, Nava N, Jorge VC, Okawa AM, Rocha VA, Forato LCH, Furuya VAO, Martins SS, Oksman D. Perioperative Immunonutrition in Elderly Patients Undergoing Total Hip and Knee Arthroplasty: Impact on Postoperative Outcomes. JPEN J Parenter Enteral Nutr 2021; 45:1559-1566. [PMID: 33044001 PMCID: PMC8518379 DOI: 10.1002/jpen.2028] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Arthroplasties in elderly patients are surgeries performed to ensure their quality of life. Perioperative care with specific nutrients can improve nutrition status and metabolic response to orthopedic surgeries, such as total knee arthroplasty (TKA) and total hip arthroplasty (THA). METHODS Retrospective study with elderly patients divided into 2 groups: control and immunonutrition. The immunonutrition group was instructed to start oral intake of the nutrition supplement 5 days before and to resume it 5 days after arthroplasty (200 mL, 3 times per day). The following were analyzed as primary and secondary outcomes: length of stay (LOS), infectious and noninfectious complications, need for intensive care unit (ICU), transfusion requirement, and C-reactive protein. RESULTS A total of 3015 elderly patients met the inclusion criteria: control group (n = 1398) and immunonutrition group (n = 1617). Overall, 81.2% were women and mean age was 72.6 ± 6.9 years. Immunonutrition group had a shorter LOS in hours (32.0 ± 19.4 vs 56.0 ± 26.4; P < .001) and lower rates of infectious complications (2.2% vs 4.6%; P < .001). Noninfectious complications and need for ICU also had lower rates in the immunonutrition group. In the logistic regression analysis, immunonutrition reduced the chance of infectious complications by 55% (odds ratio [OR], 0.45; 95% CI, 0.30-0.68; P < .001) even after adjusting for variables (OR, 0.45; 95% CI, 0.28-0.71; P < .001). CONCLUSION Perioperative immunonutrition in elderly patients undergoing THA or TKA may shorten postoperative LOS and reduce infectious and noninfectious complications and transfusion requirement.
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Affiliation(s)
| | | | - Natássia Nava
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Valeria Conceição Jorge
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Andrea Massone Okawa
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Vanessa Azevedo Rocha
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | | | - Vicky Akemi Onizuca Furuya
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Sandra Salvador Martins
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
| | - Daniel Oksman
- Department of Orthopedic SurgerySancta Maggiore Hospital, Prevent Senior Private Health OperatorSão PauloBrazil
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Golin A, Freitas CZ, Schott M, Alves BP, Brondani JE, Bender SC, Fleck J, Müller EI, Marques CT, Colpo E. Low Food Consumption Interferes with the Nutritional Status of Surgical Patients with Neoplasia of the Gastrointestinal Tract. Nutr Cancer 2021; 74:1279-1290. [PMID: 34278905 DOI: 10.1080/01635581.2021.1952452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nutritional support strongly influence the nutritional status of the surgical neoplastic patients. This study aimed to evaluate the influence of food consumption on the perioperative nutritional status of hospitalized patients with neoplasia of the upper (UGIT) and lower (LGIT) gastrointestinal tract. Methods: Observational, longitudinal, and prospective study. Data collected: food consumption, Subjective Global Assessment, anthropometry, laboratory tests. Results: Eighty patients were followed up: 43 (54%) in the UGIT and 37 (46%) in the LGIT. The consumption in the perioperative period was lower than the usual consumption in the UGIT and LGIT groups, respectively, of energy (14.2 ± 6.5; 22.8 ± 11.2 Kcal/kg/d, p < 0.001; 13.6 ± 1.2; 19.0 ± 2.0 Kcal/kg/d; p = 0.014), protein (1.1 ± 0.7; 0.6 ± 0.3 g/kg/d, p < 0.001; 0.8 ± 0.1; 0.5 ± 0.1 g/kg/d; p = 0.058), selenium, zinc and copper. Most patients presented in the UGIT and LGIT groups, respectively, worsening malnutrition and muscle depletion according to the Subjective Global Assessment (61.9%; 51.4%) and hypoalbuminemia, mainly in the UGIT in the postoperative. Conclusion: Low food consumption during the perioperative period associated with prolongation of the postoperative fasting period worsens the nutritional status of patients undergoing surgery of the gastrointestinal tract for neoplasia, especially in the UGIT group.
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Affiliation(s)
- Anieli Golin
- Nutrition, Universidade Franciscana, Santa Maria, Brazil
| | | | - Mairin Schott
- Nutrition, Universidade Franciscana, Santa Maria, Brazil
| | | | - Juliana Ebling Brondani
- Nutrition, Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Santa Maria, Brasil
| | - Silvia Cercal Bender
- Nutrition, Universidade Federal de Santa Maria, Hospital Universitário de Santa Maria, Santa Maria, Brasil
| | - Juliana Fleck
- Pharmacology, Universidade Franciscana, Santa Maria, Brazil
| | - Edson Irineu Müller
- Departamento de Quimica, Chemistry, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Clandio Timm Marques
- Statistics and Operational Research, University of Lisboa, Universidade Franciscana, Santa Maria, Brazil
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Persson J, Fagevik Olsén M, Iresjö B, Smedh U. Body composition, sarcopenia, and quality of life in patients with oesophageal cancer before resection surgery and at follow‐up: a cohort study. JCSM CLINICAL REPORTS 2020. [DOI: 10.1002/crt2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jan Persson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Monika Fagevik Olsén
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Britt‐Marie Iresjö
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
| | - Ulrika Smedh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden
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Katundu KG, Mutafya TW, Lozani NC, Nyirongo PM, Uebele ME. An observational study of perioperative nutrition and postoperative outcomes in patients undergoing laparotomy at Queen Elizabeth Central Hospital in Blantyre, Malawi. Malawi Med J 2019; 30:79-85. [PMID: 30627333 PMCID: PMC6307065 DOI: 10.4314/mmj.v30i2.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Nutritional status in patients undergoing surgery can influence their immune function, tissue repair and, hence, clinical outcomes. This study aimed to assess the perioperative nutrition and postoperative outcome of patients undergoing laparotomy at a tertiary hospital in Malawi. Methods A total of 25 patients were included in this prospective, observational study. The Subjective Global Assessment was used to classify each patient according to nutritional status. Handgrip strength was measured for each patient preoperatively and at day 3 postoperatively. Anthropometric measurements were also done. Protein and energy requirements for each participant were estimated and compared to the quantities provided by the hospital diet. Patients were followed up until discharge and outcome variables which included length of hospital stay and wound dehiscence or infectious complications were recorded. Results Of the study participants, 20% were well-nourished, 52% were moderately malnourished and 28% were severely malnourished. The median handgrip strength decreased at day 3 postoperatively from the preoperative handgrip strength. Well-nourished patients had higher handgrip strength than malnourished patients both preoperatively and postoperatively. Total energy and protein provided by the hospital diet were significantly lower than the estimated requirements for the patients. Severely malnourished patients had increased median length of hospital stay and increased rate of postoperative complications. Preoperative and postoperative day 3 handgrip strength correlated negatively with the number of postoperative complications and length of hospital stay. Conclusion This study showed high rates of malnutrition and inadequate in-hospital nutritional support which were associated with poor clinical outcomes, especially in severely malnourished patients. Proper nutritional assessment and provision of adequate nutritional support should be reinforced in surgical patients to promote favourable clinical outcomes postoperatively. Further studies with larger sample sizes in other patient populations and hospitals in Malawi are required in this area.
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Affiliation(s)
- Kondwani Gh Katundu
- Division of Physiology, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Noel C Lozani
- College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Molly E Uebele
- College of Medicine, University of Malawi, Blantyre, Malawi
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Kim JY, Wie GA, Cho YA, Kim SY, Sohn DK, Kim SK, Jun MD. Diet Modification Based on the Enhanced Recovery After Surgery Program (ERAS) in Patients Undergoing Laparoscopic Colorectal Resection. Clin Nutr Res 2018; 7:297-302. [PMID: 30406059 PMCID: PMC6209732 DOI: 10.7762/cnr.2018.7.4.297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/19/2018] [Accepted: 10/21/2018] [Indexed: 12/18/2022] Open
Abstract
The enhanced recovery after surgery (ERAS) program aims to maximize the recovery of patients by minimizing pre- and postoperative complications and stress. The program recommends providing preoperative carbohydrate (CHO) supplements and starting an early postoperative diet to reduce the fasting duration. Based on these recommendations, we implemented preoperative CHO supplementation and initiated an early postoperative diet in patients undergoing laparoscopic colorectal resection. We observed 3 patients as follows: a non-ERAS case, preoperative ERAS case, and pre- and postoperative ERAS case. The preoperative well-being and compliance of patients improved after implementation of the ERAS program. Moreover, the length of hospital stay was reduced. Therefore, we consider that the ERAS program may be helpful for the recovery of patients undergoing laparoscopic colorectal resection.
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Affiliation(s)
- Ji Yeon Kim
- Department of Clinical Nutrition, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
| | - Gyung Ah Wie
- Department of Clinical Nutrition, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
| | - Yeong Ah Cho
- Department of Clinical Nutrition, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
| | - So Young Kim
- Department of Clinical Nutrition, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
| | - Suk Kyoung Kim
- Center for Colorectal Cancer, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
| | - Mee Duck Jun
- Center for Colorectal Cancer, Research Institute & Hospital, National Cancer Center, Goyang 10408, Korea
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What Is the Role of Nutritional Supplements in Support of Total Hip Replacement and Total Knee Replacement Surgeries? A Systematic Review. Nutrients 2018; 10:nu10070820. [PMID: 29941852 PMCID: PMC6073268 DOI: 10.3390/nu10070820] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/16/2022] Open
Abstract
Nutritional supplements can influence outcomes for individuals undergoing major surgery, particularly in older persons whose functional reserve is limited. Accelerating recovery from total hip replacement (THR) and total knee replacement (TKR) may offer significant benefits. Therefore, we explored the role of nutritional supplements in improving recovery following THR and TKR. A systematic review was conducted to source randomized clinical trials that tested nutritional supplements in cohorts of THR or TKR patients. Our search yielded nine relevant trials. Intake of a carbohydrate-containing fluid is reported to improve insulin-like growth factor levels, reduce hunger, nausea, and length of stay, and attenuate the decrease in whole-body insulin sensitivity and endogenous glucose release. Amino acid supplementation is reported to reduce muscle atrophy and accelerate return of functional mobility. One paper reported a suppressive effect of beta-hydroxy beta-methylbutyrate, L-arginine, and L-glutamine supplementation on muscle strength loss following TKR. There is limited evidence for nutritional supplementation in THR and TKR pathways; however, the low risk profile and potential benefits to adjunctive treatment methods, such as exercise programs, suggest nutritional supplements may have a role. Optimizing nutritional status pre-operatively may help manage the surgical stress response, with a particular benefit for undernourished, frail, or elderly individuals.
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Mosquera C, Koutlas NJ, Edwards KC, Strickland A, Vohra NA, Zervos EE, Fitzgerald TL. Impact of malnutrition on gastrointestinal surgical patients. J Surg Res 2016; 205:95-101. [DOI: 10.1016/j.jss.2016.05.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/28/2016] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
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