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Müller J, Wiesenberger R, Kaufmann M, Weiß C, Ghezel-Ahmadi D, Hardt J, Reißfelder C, Herrle F. Motivational Interviewing improves postoperative nutrition goals within the Enhanced Recovery after Surgery (ERAS®) pathway in elective bowel surgery - A randomized clinical pilot trial. Clin Nutr ESPEN 2024; 61:181-188. [PMID: 38777431 DOI: 10.1016/j.clnesp.2024.03.023] [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: 10/27/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND & AIMS Exploration whether Motivational Interviewing (MI) could be learned and implemented with ease within a surgical in-hospital setting and whether participation in the intervention led to significantly higher compliance with ERAS®-recommended protein intake goals. The individual healing process of many patients is delayed because they fail to cover their calorie requirement, which could be counteracted by a patient-centered conversational intervention that is new in perioperative practice. METHODS This patient-blinded pilot-RCT included 60 patients (≥18 years) following the certified ERAS® bowel protocol for colorectal surgery between March and August 2022. Five perioperative MI interventions were conducted by two health employees certified to perform MI. Key endpoints were the number of protein shakes drunk, calories of proteins ingested and overall calorie intake. RESULTS A total of 60 patients (34 men [56.7%]; mean [SD] age, 60.7 [13.3] years) were randomized. MI patient-group had significantly higher protein shake intake on all postoperative days except day 3. For days 0-3 MI group drank significantly more shakes overall (median 5.5 vs. 2.0; P = 0.004) and consumed more calories (median 1650.0 vs. 600.0 kcal; P = 0.004) and proteins (median 110.0 vs. 40.0 g; P = 0.005). Total calorie intake for each day by shakes and dietary intake was significantly higher in the MI-intervention group on day 2 (mean 1772.3 vs. 1358.9 kcal; P = 0.03). CONCLUSIONS MI may contribute to improve compliance with nutritional goals in the certified ERAS® protocol by increasing protein and calorie intake. The findings suggest further investigation of MI to help patients achieve their perioperative nutrition goals in different clinical settings. TRIAL REGISTRATION DRKS - Deutsches Register Klinischer Studien; DRKS-ID: DRKS00027863; https://drks.de/search/de/trial/DRKS00027863.
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Affiliation(s)
- Julian Müller
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Rico Wiesenberger
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Mario Kaufmann
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Christel Weiß
- Institute for Medical Biometry and Statistics, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - David Ghezel-Ahmadi
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Julia Hardt
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Florian Herrle
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany.
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Bates A, West MA, Jack S, Grocott MPW. Preparing for and Not Waiting for Surgery. Curr Oncol 2024; 31:629-648. [PMID: 38392040 PMCID: PMC10887937 DOI: 10.3390/curroncol31020046] [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: 11/13/2023] [Revised: 01/22/2024] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
Cancer surgery is an essential treatment strategy but can disrupt patients' physical and psychological health. With worldwide demand for surgery expected to increase, this review aims to raise awareness of this global public health concern, present a stepwise framework for preoperative risk evaluation, and propose the adoption of personalised prehabilitation to mitigate risk. Perioperative medicine is a growing speciality that aims to improve clinical outcome by preparing patients for the stress associated with surgery. Preparation should begin at contemplation of surgery, with universal screening for established risk factors, physical fitness, nutritional status, psychological health, and, where applicable, frailty and cognitive function. Patients at risk should undergo a formal assessment with a qualified healthcare professional which informs meaningful shared decision-making discussion and personalised prehabilitation prescription incorporating, where indicated, exercise, nutrition, psychological support, 'surgery schools', and referral to existing local services. The foundational principles of prehabilitation can be adapted to local context, culture, and population. Clinical services should be co-designed with all stakeholders, including patient representatives, and require careful mapping of patient pathways and use of multi-disciplinary professional input. Future research should optimise prehabilitation interventions, adopting standardised outcome measures and robust health economic evaluation.
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Affiliation(s)
- Andrew Bates
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Malcolm A. West
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Sandy Jack
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
| | - Michael P. W. Grocott
- Perioperative and Critical Care Medicine Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton/University of Southampton, Southampton SO16 6YD, UK; (A.B.); (M.A.W.)
- Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK
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3
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Wu Y, Wang X, Gao F, Liao J, Zeng J, Fan L. Mobile nutrition and health management platform for perioperative recovery: an interdisciplinary research achievement using WeChat Applet. Front Med (Lausanne) 2023; 10:1201866. [PMID: 37293309 PMCID: PMC10244757 DOI: 10.3389/fmed.2023.1201866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 06/10/2023] Open
Abstract
Background In recent years, the number of people using mobile applications to promote health and welfare has exponentially increased. However, there are fewer applications in the field of ERAS. How to promote the rapid rehabilitation of patients with malignant tumor surgery during perioperative period and the mastery of its long-term nutritional state is a problem to be solved. Objective The purpose of this study is to design and develop a mobile application, and use Internet technology to better manage nutritional health to achieve rapid recovery of patients with malignant tumor surgery. Methods This study is divided into three stages: (1) Design: use participating design to make the MHEALTH APP adapt to the clinical practice of nutritional health management; (2) Development: the WeChat Applet of Nutrition and Health Assessment (WANHA) developed using the Internet technology development, and web management programs. (3) Procedure test: patients and medical staff evaluate WANHA's quality (UMARS), availability (SUS), and satisfaction, and conduct semi-structured interviews. Results In this study, 192 patients with malignant tumor surgery, 20 medical staff used WANHA. Patients with nutritional risks are supported by supporting treatment. The results show that patients who have not been treated during the perioperative period, the incidence of postoperative complications (22.4%) and the average hospitalization time after surgery decreased significantly. The incidence of nutritional risks is nearly more than the preoperative level. 45 patients and 20 medical staff participated in the survey of WANHA's SUS, UMARS, and satisfaction. In the interview, most patients and medical personnel believe that the procedure can improve the current medical services and nutritional health knowledge levels, promote the communication of medical staff and patients, and strengthen the nutritional health management of patients with malignant tumors under the concept of ERAS. Conclusion WeChat Applet of Nutrition and Health Assessment is a MHEALTH APP that enhances the nutrition and health management of patients with perioperative period. It can play a huge role in improving medical services, increasing patient satisfaction, and ERAS.
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Affiliation(s)
- YuJia Wu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xin Wang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Feng Gao
- Department of Anesthesiology, The Sixth People’s Hospital of Chongqing, Chongqing, China
| | - JinRong Liao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Jie Zeng
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lin Fan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biometal Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Hogenbirk RNM, Hentzen JEKR, van der Plas WY, Campmans-Kuijpers MJE, Kruijff S, Klaase JM. Surgery-Related Muscle Loss after Pancreatic Resection and Its Association with Postoperative Nutritional Intake. Cancers (Basel) 2023; 15:cancers15030969. [PMID: 36765926 PMCID: PMC9913550 DOI: 10.3390/cancers15030969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/28/2023] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
To study the occurrence of surgery-related muscle loss (SRML) and its association with in-hospital nutritional intake, we conducted a prospective observational cohort study including patients who underwent pancreatic surgery because of (suspected) malignant diseases. Muscle diameter was measured by using bedside ultrasound 1 day prior to surgery and 7 days postoperatively. Clinically relevant SRML was defined as ≥10% muscle diameter loss in minimally one arm and leg muscle within 1 week after surgery. Protein and caloric intake was measured by nutritional diaries. The primary endpoint included the number of patients with SRML. Secondary endpoints included the association between SRML and postoperative nutritional intake. Of the 63 included patients (60.3% men; age 67.1 ± 10.2 years), a total of 24 patients (38.1%) showed SRML. No differences were observed in severe complication rate or length of hospital stay between patients with and without SRML. During the first postoperative week, patients with clinically relevant SRML experienced more days without any nutritional intake compared with the non-SRML group (1 [0-4] versus 0 [0-1] days, p = 0.007). Significantly lower nutritional intake was found in the SRML group at postoperative days 2, 3 and 5 (p < 0.05). Since this study shows that SRML occurred in 38.1% of the patients and most of the patients failed to reach internationally set nutritional goals, it is suggested that more awareness concerning direct postoperative nutritional intake is needed in our surgical community.
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Affiliation(s)
- Rianne N. M. Hogenbirk
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Correspondence:
| | - Judith E. K. R. Hentzen
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Willemijn Y. van der Plas
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Marjo J. E. Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Joost M. Klaase
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
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[Malnutrition management of hospitalized patients with diabetes/hyperglycemia un the perioperative setting]. NUTR HOSP 2022; 39:31-39. [PMID: 36546328 DOI: 10.20960/nh.04509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction People with diabetes are at high risk of requiring surgical intervention throughout their lives, and of perioperative complications in case of poor metabolic control. Hospitalization represents a stressful event that, together with other factors associated with diagnostic and therapeutic procedures, leads to a deterioration in the nutritional status of the patients. An association between poor nutritional status and adverse outcomes in surgical patients has been observed. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) in the perioperative setting.
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Muacevic A, Adler JR, Konanur Srinivasa NK, Gande A, Anusha M, Dar H. Nutrition Care in Cancer Surgery Patients: A Narrative Review of Nutritional Screening and Assessment Methods and Nutritional Considerations. Cureus 2022; 14:e33094. [PMID: 36721576 PMCID: PMC9884126 DOI: 10.7759/cureus.33094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 12/30/2022] Open
Abstract
Malignancy is a catabolic state, which is precipitated with surgical intervention. Malnutrition is one of the main risk factors for poor outcomes of cancer surgery. We need to screen oncological patients for malnutrition using standardized screening tools, by which patients found to be at nutritional risk are then referred to a registered dietitian for further management. A detailed assessment is required in such patients, which helps in categorizing the patients based on the severity and rendering proper care. Preoperative nutrition care is often overlooked because of the urgency of operating on a cancer patient. Still, studies have shown preoperative nutritional building gives better surgical outcomes and good postoperative quality of life. Preoperative nutrition care includes both early and late preoperative care. For efficient preoperative nutrition care publishing, standard operating procedures at every healthcare center are recommended. Postoperative nutrition care is given to build the patient tackle the surgical trauma, and their diet mainly includes protein to minimize catabolism. Regardless of the route of nutrition delivery, providing appropriate nutrition care in the postoperative period improves cancer patients' condition drastically. Early postoperative nutrition is studied in different cancer surgeries and is considered ideal in cancer surgical patients. There is a need for consensus on the composition of postoperative nutrition. The diet of a cancer patient should include micronutrients like vitamins D and B and minerals along with the usual nutrition care. The use of special diets like branched-chain amino acids and immune nutrition is to be considered on a case-by-case basis and introducing them into the routine care of a patient needs to be studied extensively.
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Kang B, Zhao ZQ, Liu XY, Cheng YX, Tao W, Wei ZQ, Peng D. Effect of hypoalbuminemia on short-term outcomes after colorectal cancer surgery: A propensity score matching analysis. Front Nutr 2022; 9:925086. [PMID: 36105581 PMCID: PMC9464913 DOI: 10.3389/fnut.2022.925086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/29/2022] [Indexed: 12/09/2022] Open
Abstract
Purpose The purpose of our study was to investigate the effect of pre-operative hypoalbuminemia on the short-term outcomes after primary colorectal cancer (CRC) surgery. Materials and methods The retrospective study enrolled CRC patients who underwent primary surgery from January 2011 to December 2021 in a single teaching hospital. The short-term outcomes were compared between the hypoalbuminemia group and the normal group using propensity score matching (PSM). Univariate and multivariate logistic regression analyses were used for analyzing independent predictors of overall complications and major complications. Results A total of 7,072 patients from a single center were enrolled in this study. There were 1,078 (15.2%) patients in the pre-operative hypoalbuminemia group and 5,994 (84.8%) patients in the normal pre-operative albumin group. After 1:1 PSM, there were 1,028 patients in the hypoalbuminemia group and 1,028 patients in the normal group. No significant differences were found in baseline information between the two groups after PSM. In terms of short-term outcomes, the hypoalbuminemia group had a longer operation time (p = 0.003), greater volume of blood loss (p = 0.036), longer hospital stays (p < 0.01), higher proportion of overall complications (p = 0.003), major complications (p = 0.016), higher incidence of pneumonia and abdominal infection (p = 0.001) than the normal group after PSM. Furthermore, hypoalbuminemia was an independent predictor for overall complications (p = 0.008) and major complications (p = 0.016). Conclusion Pre-operative hypoalbuminemia increased overall complications and major complications after primary CRC surgery. Furthermore, hypoalbuminemia was an independent predictor for overall complications and major complications.
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Affiliation(s)
- Bing Kang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Clinical Nutrition, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Qiang Zhao
- Department of General Surgery, Qijiang Hospital of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Yu Liu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-Xi Cheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Tao
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zheng-Qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dong Peng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Dong Peng,
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Corriveau J, Alavifard D, Gillis C. Demystifying Malnutrition to Improve Nutrition Screening and Assessment in Oncology. Semin Oncol Nurs 2022; 38:151336. [PMID: 35995630 DOI: 10.1016/j.soncn.2022.151336] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients with cancer and malnutrition are more likely to experience poor treatment tolerance, prolonged length of hospital stay, and decreased quality of life. Early and sustained nutrition risk screening is the first step to tackling this patient and health care burden. Yet, malnutrition remains largely overlooked and undertreated. Malnutrition mismanagement could be indicative of a systemic misunderstanding. With this narrative review, we aimed to (1) define malnutrition, (2) address common malnutrition misconceptions, and (3) summarize nutrition recommendations for patients with cancer. DATA SOURCES PubMed and international clinical practice guidelines were used. CONCLUSION Malnutrition represents an unbalanced nutritional state that alters body composition and diminishes function. Malnutrition is not always physically obvious, and albumin is not a reliable marker of nutritional status; therefore, systematically screening all patients with a validated nutrition risk screening tool at time of cancer diagnosis, and periodically throughout treatment, is necessary to provide optimal, equitable care. Nutrition risk screening takes less than 1 minute to complete and can be completed by any health care professional. Patients that screen positive for nutrition risk should be referred to a registered nutritionist or dietitian for comprehensive nutritional assessment, diagnosis, and treatment. IMPLICATIONS FOR NURSING PRACTICE All health care professionals can and should be responsible for preventing and treating malnutrition. Registered nurses can actively participate in improving patient outcomes by screening patients for nutrition risk, weighing patients at every visit, referring patients to dietitians for nutrition treatment, and providing supportive medical management of nutrition impact symptoms such as nausea.
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Affiliation(s)
- Jade Corriveau
- Department of Nutrition, McGill University Health Centre, Montreal, QC, Canada
| | - Dorsa Alavifard
- Department of Anesthesia, McGill University, Montreal, QC, Canada
| | - Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, QC, Canada; Department of Surgery, McGill University, Montreal, QC, Canada; School of Human Nutrition, McGill University, McGill University, Montreal, QC, Canada.
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Abstract
Objective: To systematically review the problem of appetite loss after major abdominal surgery. Summary of Background Data: Appetite loss is a common problem after major abdominal surgery. Understanding of etiology and treatment options is limited. Methods: We searched Medline, Cochrane Central Register of Controlled Trials, and Web of Science for studies describing postoperative appetite loss. Data were extracted to clarify definition, etiology, measurement, surgical influence, pharmacological, and nonpharmacological treatment. PROSPERO registration ID: CRD42021224489. Results: Out of 6144 articles, we included 165 studies, 121 of which were also analyzed quantitatively. A total of 19.8% were randomized, controlled trials (n = 24) and 80.2% were nonrandomized studies (n = 97). The studies included 20,506 patients undergoing the following surgeries: esophageal (n = 33 studies), gastric (n = 48), small bowel (n = 6), colon (n = 27), rectal (n = 20), hepatobiliary (n = 6), and pancreatic (n = 13). Appetite was mostly measured with the Quality of Life Questionnaire of the European Organization for Research and Treatment of Cancer (EORTC QLQ C30, n = 54). In a meta-analysis of 4 randomized controlled trials gum chewing reduced time to first hunger by 21.2 hours among patients who had bowel surgery. Other reported treatment options with positive effects on appetite but lower levels of evidence include, among others, intravenous ghrelin administration, the oral Japanese herbal medicine Rikkunshito, oral mosapride citrate, multidisciplin-ary-counseling, and watching cooking shows. No studies investigated the effect of well-known appetite stimulants such as cannabinoids, steroids, or megestrol acetate on surgical patients. Conclusions: Appetite loss after major abdominal surgery is common and associated with increased morbidity and reduced quality of life. Recent studies demonstrate the influence of reduced gastric volume and ghrelin secretion, and increased satiety hormone secretion. There are various treatment options available including level IA evidence for postoperative gum chewing. In the future, surgical trials should include the assessment of appetite loss as a relevant outcome measure.
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Matthews LS, Wootton SA, Davies SJ, Levett DZH. Screening, assessment and management of perioperative malnutrition: a survey of UK practice. Perioper Med (Lond) 2021; 10:30. [PMID: 34433498 PMCID: PMC8390283 DOI: 10.1186/s13741-021-00196-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/31/2021] [Indexed: 01/04/2023] Open
Abstract
Background Perioperative malnutrition is common and is associated with increased mortality, complications and healthcare costs. Patients having surgery for cancer and gastro-intestinal disease are at particular risk. It is a modifiable pre-operative risk factor and perioperative clinicians are well placed to identify those at risk and instigate interventions shown to improve outcome. Thus, we conducted a survey of Perioperative Medicine Leads with the aim of assessing the current provision of nutritional screening and intervention pathways in the UK. Methods Perioperative Medicine Leads registered with the Royal College of Anaesthetists were asked to complete an online survey exploring current practice in screening, assessment and management of malnutrition in the perioperative period. The survey included a mixture of open and closed questions, graded response questions and options for free text. Where a response was not received, departments were phoned directly and e-mails sent to non-responders. Results We received 121 completed questionnaires from 167 Perioperative Medicine Leads (response rate of 72.5%). Seventy respondents (57.9%) reported using the Malnutrition Universal Screening Tool to screen patients; however, only 61 (50.4%) referred patients at nutritional risk onto a dietitian. Sixty (49.6%) lacked confidence in local ability to identify and manage malnutrition perioperatively, with 28 (23.1%) reporting having a structured pathway for managing malnourished patients. One hundred eleven respondents (91.7%) agreed that malnutrition impacts on quality of life after surgery and 105 (86.8%) felt adopting a standard protocol would improve outcomes for patients. Those reporting a lack of confidence in dealing with malnutrition perioperatively cited a lack of organisational support, patients being seen too close to surgery and lack of clarity around responsibility as key reasons for difficulties in managing this group of patients. Conclusions Malnutrition in the perioperative period is a modifiable risk factor which is common and results in increased morbidity for patients and increased cost to healthcare systems. This survey highlights areas of practice where perioperative clinicians can improve the assessment and management of patients at nutritional risk prior to elective surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13741-021-00196-2.
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Affiliation(s)
- L S Matthews
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK. .,University of Southampton, Southampton, UK.
| | - S A Wootton
- University of Southampton, Southampton, UK.,National Institute for Health Research Cancer and Nutrition Collaboration, Southampton, UK
| | - S J Davies
- Department of Dietetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Z H Levett
- Department of Perioperative Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.,University of Southampton, Southampton, UK
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Hasil L, Fenton TR, Ljungqvist O, Gillis C. From clinical guidelines to practice: The nutrition elements for enhancing recovery after colorectal surgery. Nutr Clin Pract 2021; 37:300-315. [PMID: 34339542 DOI: 10.1002/ncp.10751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The Enhanced Recovery After Surgery (ERAS) Care System improves patient outcomes. The ERAS Protocol describes multimodal, evidence-based processes that are bundled into >20 care elements, and the ERAS Implementation Program provides strategies to guide the successful adoption of the care elements. Although formal training is essential to implement ERAS correctly, with this article we aim to bridge the gap between the nutritionally relevant care elements of the protocol and their implementation for colorectal surgery. This article also describes how dietitians can support optimal patient outcomes by playing an active role in implementing, monitoring, and evaluating ERAS practices.
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Affiliation(s)
- Leslee Hasil
- Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Tanis R Fenton
- Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada.,Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Chelsia Gillis
- Department of Anesthesia, McGill University Health Center, Montreal, Quebec, Canada
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12
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Rattray M, Marshall AP, Desbrow B, von Papen M, Roberts S. Assessment of an integrated knowledge translation intervention to improve nutrition intakes among patients undergoing elective bowel surgery: a mixed-method process evaluation. BMC Health Serv Res 2021; 21:514. [PMID: 34044842 PMCID: PMC8161936 DOI: 10.1186/s12913-021-06493-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 05/06/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND A large evidence-practice gap exists regarding provision of nutrition to patients following surgery. The aim of this study was to evaluate the processes supporting the implementation of an intervention designed to improve the timing and adequacy of nutrition following bowel surgery. METHODS A mixed-method pilot study, using an integrated knowledge translation (iKT) approach, was undertaken at a tertiary teaching hospital in Australia. A tailored, multifaceted intervention including ten strategies targeted at staff or patients were co-developed with knowledge users at the hospital and implemented in practice. Process evaluation outcomes included reach, intervention delivery and staffs' responses to the intervention. Quantitative data, including patient demographics and surgical characteristics, intervention reach, and intervention delivery were collected via chart review and direct observation. Qualitative data (responses to the intervention) were sequentially collected from staff during one-on-one, semi-structured interviews. Quantitative data were summarized using median (IQR), mean (SD) or frequency(%), while qualitative data were analysed using content analysis. RESULTS The intervention reached 34 patients. Eighty-four percent of nursing staff received an awareness and education session, while 0% of medical staff received a formal orientation or awareness and education session, despite the original intention to deliver these sessions. Several strategies targeted at patients had high fidelity, including delivery of nutrition education (92%); and prescription of oral nutrition supplements (100%) and free fluids immediately post-surgery (79%). Prescription of a high energy high protein diet on postoperative day one (0%) and oral nutrition supplements on postoperative day zero (62%); and delivery of preoperative nutrition handout (74%) and meal ordering education (50%) were not as well implemented. Interview data indicated that staff regard nutrition-related messages as important, however, their acceptance, awareness and perceptions of the intervention were mixed. CONCLUSIONS Approximately half the patient-related strategies were implemented well, which is likely attributed to the medical and nursing staff involved in intervention design championing these strategies. However, some strategies had low delivery, which was likely due to the varied awareness and acceptance of the intervention among staff on the ward. These findings suggest the importance of having buy-in from all staff when using an iKT approach to design and implement interventions.
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Affiliation(s)
- Megan Rattray
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.
| | - Andrea P Marshall
- School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport Qld, Gold Coast, 4215, Australia
| | - Ben Desbrow
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia
| | - Michael von Papen
- Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport Qld, Gold Coast, 4215, Australia
| | - Shelley Roberts
- School of Allied Health Sciences, Griffith University, Gold Coast Campus, Gold Coast, QLD, 4222, Australia.,Gold Coast Hospital and Health Service, 1 Hospital Boulevard Southport Qld, Gold Coast, 4215, Australia
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13
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Constansia RDN, Hentzen JEKR, Hogenbirk RNM, van der Plas WY, Campmans-Kuijpers MJE, Buis CI, Kruijff S, Klaase JM. Actual postoperative protein and calorie intake in patients undergoing major open abdominal cancer surgery: A prospective, observational cohort study. Nutr Clin Pract 2021; 37:183-191. [PMID: 33979002 PMCID: PMC9292321 DOI: 10.1002/ncp.10678] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Adequate nutritional protein and energy intake are required for optimal postoperative recovery. There are limited studies reporting the actual postoperative protein and energy intake within the first week after major abdominal cancer surgery. The main objective of this study was to quantify the protein and energy intake after major abdominal cancer surgery. Methods We conducted a prospective cohort study. Nutrition intake was assessed with a nutrition diary. The amount of protein and energy consumed through oral, enteral, and parenteral nutrition was recorded and calculated separately. Based on the recommendations of the European Society for Clinical Nutrition and Metabolism (ESPEN), protein and energy intake were considered insufficient when patients received <1.5 g/kg protein and 25 kcal/kg for 2 or more days during the first postoperative week. Results Fifty patients were enrolled in this study. Mean daily protein and energy intake was 0.61 ± 0.44 g/kg/day and 9.58 ± 3.33 kcal/kg/day within the first postoperative week, respectively. Protein and energy intake were insufficient in 45 [90%] and 41 [82%] of the 50 patients, respectively. Patients with Clavien‐Dindo grade ≥III complications consumed less daily protein compared with the group of patients without complications and patients with grade I or II complications. Conclusion During the first week after major abdominal cancer surgery, the majority of patients do not consume an adequate amount of protein and energy. Incorporating a registered dietitian into postoperative care and adequate nutrition support after major abdominal cancer surgery should be a standard therapeutic goal to improve nutrition intake.
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Affiliation(s)
| | - Judith E K R Hentzen
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Rianne N M Hogenbirk
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Marjo J E Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, the Netherlands
| | - Carlijn I Buis
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Joost M Klaase
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
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14
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Gillis C, Richer L, Fenton TR, Gramlich L, Keller H, Culos-Reed SN, Sajobi TT, Awasthi R, Carli F. Colorectal cancer patients with malnutrition suffer poor physical and mental health before surgery. Surgery 2021; 170:841-847. [PMID: 33966805 DOI: 10.1016/j.surg.2021.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND To determine whether there is an association between preoperative nutritional status and preoperative physical function, patient-reported quality of life, and body composition in colorectal cancer patients awaiting elective surgery. METHODS We conducted a pooled analysis of individual baseline patient data (n = 266) collected from 5 prehabilitation trials in colorectal cancer surgery. All data were collected approximately 4 weeks before surgery. Each patient's nutritional status was evaluated using the Patient-Generated Subjective Global Assessment: scores 4-8 indicated need for nutritional treatment, whereas ≥9 indicated critical need for a nutrition intervention. Physical function was measured with the 6-minute walk test; patient-reported quality of life was captured with the SF-36; body mass and composition were determined using multifrequency bioelectrical impedance. RESULTS Mean Patient-Generated Subjective Global Assessment score was 5.3 (standard deviation: 3.9). Approximately two-thirds of patients had a Patient-Generated Subjective Global Assessment of 4-8 or ≥9 (n = 162/266). The 6-minute walk test was progressively worse with higher Patient-Generated Subjective Global Assessment scores (PG-SGA <4: 471(119) m; PG-SGA 4-8: 417(125) m; PG-SGA ≥9: 311(125) m, P < .001). Every component of the SF-36 was lower in those with a Patient-Generated Subjective Global Assessment ≥9 compared to Patient-Generated Subjective Global Assessment <4, indicating that malnourished patients suffer worse quality of life. Interestingly, only the male patients with a Patient-Generated Subjective Global Assessment ≥9 presented with statistically significant lower body mass, reduced fat-free mass index, and a lower percent body fat relative to those with Patient-Generated Subjective Global Assessment <4, in part due to the higher variability among the females. CONCLUSION The consequences of malnutrition are far-reaching and are strongly associated with the physical and mental health of colorectal cancer patients awaiting elective resection.
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Affiliation(s)
- Chelsia Gillis
- Department of Anesthesia, McGill University, Montreal, Canada.
| | - Lauren Richer
- Department of Anesthesia, McGill University, Montreal, Canada
| | - Tanis R Fenton
- Department of Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada; Nutrition Services, Alberta Health Services, Calgary, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Heather Keller
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology and Department of Oncology, Cumming School of Medicine, University of Calgary; Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, Alberta, Canada
| | - Tolulope T Sajobi
- Cumming School of Medicine, Department of Community Health Sciences and O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Rashami Awasthi
- Department of Anesthesia, McGill University, Montreal, Canada
| | - Francesco Carli
- Department of Anesthesia, McGill University, Montreal, Canada
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15
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Nurkkala J, Lahtinen S, Ylimartimo A, Kaakinen T, Vakkala M, Koskela M, Liisanantti J. Nutrition delivery after emergency laparotomy in surgical ward: a retrospective cohort study. Eur J Trauma Emerg Surg 2021; 48:113-120. [PMID: 33797561 PMCID: PMC8825430 DOI: 10.1007/s00068-021-01659-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Adequate nutrition after major abdominal surgery is associated with less postoperative complications and shorter hospital length of stay (LOS) after elective procedures, but there is a lack of studies focusing on the adequacy of nutrition after emergency laparotomies (EL). The aim of the present study was to investigate nutrition adequacy after EL in surgical ward. METHODS The data from 405 adult patients who had undergone emergency laparotomy in Oulu University Hospital (OUH) between years 2015 and 2017 were analyzed retrospectively. Nutrition delivery and complications during first 10 days after the operation were evaluated. RESULTS There was a total of 218 (53.8%) patients who were able to reach cumulative 80% nutrition adequacy during the first 10 postoperative days. Patients with adequate nutrition (> 80% of calculated calories) met the nutritional goals by the second postoperative day, whereas patients with low nutrition delivery (< 80% of calculated calories) increased their caloric intake during the first 5 postoperative days without reaching the 80% level. In multivariate analysis, postoperative ileus [4.31 (2.15-8.62), P < 0.001], loss of appetite [3.59 (2.18-5.93), P < 0.001] and higher individual energy demand [1.004 (1.003-1.006), P = 0.001] were associated with not reaching the 80% nutrition adequacy. CONCLUSIONS Inadequate nutrition delivery is common during the immediate postoperative period after EL. Oral nutrition is the most efficient way to commence nutrition in this patient group in surgical ward. Nutritional support should be closely monitored for those patients unable to eat. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- Juho Nurkkala
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland.
| | - Sanna Lahtinen
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Aura Ylimartimo
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Timo Kaakinen
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Merja Vakkala
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Marjo Koskela
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
| | - Janne Liisanantti
- Medical Research Centre and Research Group of Surgery, Anesthesia and Intensive Care, Department of Anesthesiology, University of Oulu, Oulu University Hospital, P.O. Box 21, 90029, Oulu, Finland
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16
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Hubert M, Gabriel D, El Khouda S, Coster M, Routiaux C, Hans G, Nihant N, Joris J. Energy and Protein Intake After Return Home in Colorectal Surgery Patients With an Enhanced Recovery Program: A Prospective Observational Study. Nutr Clin Pract 2021; 36:639-647. [PMID: 33410538 DOI: 10.1002/ncp.10617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In patients scheduled for colorectal surgery with an enhanced recovery program (ERP), feeding after returning home has been insufficiently investigated. The aim of this study was to measure energy and protein intake during the first month at home. METHODS Seventy adult patients scheduled for colorectal surgery with ERP were included. Calorie and protein intakes were calculated, and body weight was measured preoperatively and 3, 7, 15, and 30 days after discharge home. Data are mean ± SD or median (interquartile range). RESULTS Patient characteristics were age 60.0 ± 15.0 years, BMI = 25.9 ± 5.5 kg/m2 , and colon/rectum of 56/14. The duration of hospitalization was 3 (2-5) days. Calorie and protein intakes (21.9 [17.7-28.6] kilocalorie per kilogram of ideal body weight [kcal/kg IBW] and 0.81 [0.61-1.14] g/kg IBW) were significantly reduced (P < .01) by 15% on day 3, compared with preoperative values, and then increased gradually to reach preoperative values after 1 month. Almost 50% of the patients failed to reach the calorie intake target of 25 kcal/kg IBW, and almost no patient reached the protein intake target of 1.5 g/kg IBW 30 days after discharge home. Weight loss after 30 days at home remained at -1.8 ± 2.7 kg. CONCLUSIONS Colorectal surgery, even in an ERP, is associated with energy and protein intake below the targets recommended for the rehabilitation phase and results in weight loss. Whether nutrition counseling and prolonged administration of protein-enriched oral supplements could accelerate weight gain needs to be explored.
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Affiliation(s)
- Mégane Hubert
- Department of Anesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Dominique Gabriel
- Dietary and Nutrition Services, CHU Liège, University of Liège, Liège, Belgium
| | - Soraya El Khouda
- Dietary and Nutrition Services, CHU Liège, University of Liège, Liège, Belgium
| | - Marine Coster
- Haute Ecole de la Province de Liège, Dietetics Section, Jemeppe, Belgium
| | - Clara Routiaux
- Haute Ecole de la Province de Liège, Dietetics Section, Jemeppe, Belgium
| | - Gregory Hans
- Department of Anesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium
| | - Nicole Nihant
- Haute Ecole de la Province de Liège, Dietetics Section, Jemeppe, Belgium
| | - Jean Joris
- Department of Anesthesia and Intensive Care Medicine, CHU Liège, University of Liège, Liège, Belgium.,Groupe francophone de réhabilitation améliorée après chirurgie (GRACE; Francophone group for enhanced recovery after surgery), Beaumont, France
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17
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Computed-Tomography Body Composition Analysis Complements Pre-Operative Nutrition Screening in Colorectal Cancer Patients on an Enhanced Recovery after Surgery Pathway. Nutrients 2020; 12:nu12123745. [PMID: 33291416 PMCID: PMC7762071 DOI: 10.3390/nu12123745] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 12/24/2022] Open
Abstract
Pre-operative nutrition screening is recommended to identify cancer patients at risk of malnutrition, which is associated with poor outcomes. Low muscle mass (sarcopenia) and lipid infiltration to muscle cells (myosteatosis) are similarly associated with poor outcomes but are not routinely screened for. We investigated the prevalence of sarcopenia and myosteatosis across the nutrition screening triage categories of the Patient-Generated Subjective Global Assessment Short Form (PG-SGASF) in a pre-operative colorectal cancer (CRC) cohort. Data were prospectively collected from patients scheduled for surgery at two sites in Edmonton, Canada. PG-SGASF scores ≥ 4 identified patients at risk for malnutrition; sarcopenia and myosteatosis were identified using computed-tomography (CT) analysis. Patients (n = 176) with a mean age of 63.8 ± 12.0 years, 52.3% male, 90.3% with stage I–III disease were included. Overall, 25.2% had PG-SGASF score ≥ 4. Sarcopenia alone, myosteatosis alone or both were identified in 14.0%, 27.3%, and 6.4% of patients, respectively. Sarcopenia and/or myosteatosis were identified in 43.4% of those with PG-SGASF score < 4 and in 58.5% of those with score ≥ 4. Overall, 32.9% of the cohort had sarcopenia and/or myosteatosis with PG-SGASF score < 4. CT-defined sarcopenia and myosteatosis are prevalent in pre-operative CRC patients, regardless of the presence of traditional nutrition risk factors (weight loss, problems eating); therefore, CT image analysis effectively adds value to nutrition screening by identifying patients with other risk factors for poor outcomes.
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18
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Pasechnik IN, Rybintsev VY, Markelov KM. [Perioperative nutritional support for surgical patients]. Khirurgiia (Mosk) 2020:95-103. [PMID: 33047592 DOI: 10.17116/hirurgia202010195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The article presents an algorithm for perioperative nutritional support of surgical patients operated on as planned. Today, planned surgical care is provided in accordance with the canons of the accelerated rehabilitation Program (ARP). The relevance of the problem of nutritional insufficiency, which is an important component of ARP, is due to the dependence of the results of surgical treatment on the initial nutritional status of the patient. Methods of screening for nutritional deficiency and options for correcting protein-energy disorders are described. The predominant method is the enteral delivery of nutrients and energy. Oral supplemental nutrition by sipping is a convenient way to correct nutritional disorders at all stages of the perioperative period.
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Affiliation(s)
- I N Pasechnik
- Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
| | - V Yu Rybintsev
- Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
| | - K M Markelov
- Central State Medical Academy of the President of the Russian Federation, Moscow, Russia
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19
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Wischmeyer PE, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Gan TJ, Shaw AD, Thacker JKM, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesth Analg 2019; 126:1883-1895. [PMID: 29369092 DOI: 10.1213/ane.0000000000002743] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized.
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Affiliation(s)
- Paul E Wischmeyer
- From the Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | | | - David C Evans
- Department of Surgery, Division of Trauma, Critical Care, and Burn, Ohio State University, Columbus, Ohio
| | | | - Rosemary Kozar
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Aurora Pryor
- Department of Surgery, Stony Brook Medicine, Stony Brook, New York
| | - Robert H Thiele
- Departments of Anesthesiology and Biomedical Engineering, Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Sotiria Everett
- Nutrition Division, Department of Family, Population, Preventive Medicine, Stony Brook Medicine, Stony Brook, New York
| | - Mike Grocott
- Respiratory and Critical Care Research Area, National Institute of Health Research Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom.,Southampton National Health Service Foundation Trust, Integrative Physiology and Critical Illness Group, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Morpheus Collaboration, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Tong J Gan
- Department of Anesthesiology, Stony Brook University School of Medicine, Stony Brook, New York
| | - Andrew D Shaw
- Vanderbilt University School of Medicine, Nashville, Tennessee.,Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Julie K M Thacker
- Department of Surgery, Division of Advanced Oncologic and Gastrointestinal Surgery
| | - Timothy E Miller
- Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Durham, North Carolina
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20
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Gillis C, Wischmeyer PE. Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia 2019; 74 Suppl 1:27-35. [PMID: 30604414 DOI: 10.1111/anae.14506] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2018] [Indexed: 01/04/2023]
Abstract
Pre-operative nutrition therapy is increasingly recognised as an essential component of surgical care. The present review has been formatted using Simon Sinek's Golden Circle approach to explain 'why' avoiding pre-operative malnutrition and supporting protein anabolism are important goals for the elective surgical patient, 'how' peri-operative malnutrition develops leading in part to a requirement for pre-operative anabolic preparation, and 'what' can be done to avoid pre-operative malnutrition and support anabolism for optimal recovery.
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Affiliation(s)
- C Gillis
- Peri-Operative Program, McGill University, Montreal, QC, Canada
| | - P E Wischmeyer
- Director of Peri-operative Research, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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21
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Gillis C, Martin L, Gill M, Gilmour L, Nelson G, Gramlich L. Food Is Medicine: A Qualitative Analysis of Patient and Institutional Barriers to Successful Surgical Nutrition Practices in an Enhanced Recovery After Surgery Setting. Nutr Clin Pract 2018; 34:606-615. [DOI: 10.1002/ncp.10215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Chelsia Gillis
- Department of Community Health Sciences; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Lisa Martin
- Agricultural; Food and Nutritional Sciences; University of Alberta; Edmonton Alberta Canada
| | - Marlyn Gill
- PaCER Innovates; University of Calgary; Calgary Alberta Canada
| | - Loreen Gilmour
- Enhanced Recovery After Surgery Alberta; Alberta Health Services; Alberta Canada
| | - Gregg Nelson
- Department of Oncology; Cumming School of Medicine; University of Calgary; Calgary Alberta Canada
| | - Leah Gramlich
- Department of Medicine; University of Alberta; Edmonton Alberta Canada
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22
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Prehabilitation Prior to Major Cancer Surgery: Training for Surgery to Optimize Physiologic Reserve to Reduce Postoperative Complications. CURRENT ANESTHESIOLOGY REPORTS 2018. [DOI: 10.1007/s40140-018-0300-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Haase GM. Embracing early recovery after surgery (ERAS) protocols: Is it time for otolaryngology to join the parade? Am J Otolaryngol 2018; 39:652-653. [PMID: 29937105 DOI: 10.1016/j.amjoto.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 01/30/2023]
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24
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Martin L, Gillis C, Atkins M, Gillam M, Sheppard C, Buhler S, Hammond CB, Nelson G, Gramlich L. Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery. JPEN J Parenter Enteral Nutr 2018; 43:206-219. [DOI: 10.1002/jpen.1417] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/04/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Lisa Martin
- AgriculturalFood and Nutritional SciencesUniversity of Alberta Edmonton Alberta Canada
| | - Chelsia Gillis
- Department of Community Health SciencesCumming School of MedicineUniversity of Calgary Calgary Alberta Canada
| | - Marlis Atkins
- Nutrition ServicesAlberta Health Services Edmonton Alberta Canada
| | - Melani Gillam
- Nutrition ServicesAlberta Health Services Calgary Alberta Canada
| | - Caroline Sheppard
- Surgery Strategic Clinical NetworkAlberta Health Services Edmonton Alberta Canada
| | - Sue Buhler
- Nutrition ServicesAlberta Health Services Edmonton Alberta Canada
| | | | - Gregg Nelson
- Department of OncologyUniversity of Calgary Calgary Alberta Canada
| | - Leah Gramlich
- AgriculturalFood and Nutritional SciencesUniversity of Alberta Edmonton Alberta Canada
- Division of GastroenterologyDepartment of MedicineUniversity of Alberta Edmonton Alberta Canada
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25
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Byrnes A, Worrall J, Young A, Mudge A, Banks M, Bauer J. Early post-operative diet upgrade in older patients may improve energy and protein intake but patients still eat poorly: an observational pilot study. J Hum Nutr Diet 2018; 31:818-824. [DOI: 10.1111/jhn.12572] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- A. Byrnes
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Worrall
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
| | - A. Young
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
- School of Exercise and Nutrition Sciences; Queensland University of Technology; Kelvin Grove QLD Australia
| | - A. Mudge
- Internal Medicine and Aged Care; Royal Brisbane and Women's Hospital; Herston QLD Australia
- Institute for Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove QLD Australia
- School of Medicine; The University of Queensland; St Lucia QLD Australia
| | - M. Banks
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Herston QLD Australia
| | - J. Bauer
- School of Human Movement and Nutrition Sciences; The University of Queensland; St Lucia QLD Australia
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Elias KM. Understanding Enhanced Recovery After Surgery Guidelines: An Introductory Approach. J Laparoendosc Adv Surg Tech A 2017; 27:871-875. [DOI: 10.1089/lap.2017.0342] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Kevin M. Elias
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology and Reproductive Biology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Surgical ICU Translational Research Center, Brigham and Women's Hospital, Boston, Massachusetts
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Partoune A, Coimbra C, Brichant JF, Joris J. Quality of life at home and satisfaction of patients after enhanced recovery protocol for colorectal surgery. Acta Chir Belg 2017; 117:176-180. [PMID: 28103758 DOI: 10.1080/00015458.2017.1279871] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Quality of life of patients at home after an enhanced recovery protocol (ERP) for surgery has been least studied especially in elderly patients. METHODS Our first 41 patients entered in the colorectal GRACE database were interviewed through telephone about their postoperative stress, fatigue, pain, difficulty in feeding, home autonomy, and satisfaction. We compared the responses of the elderly patients (>70 years, n = 19) with those of the younger patients. RESULTS The time between the surgery and the questionnaire was 79 ± 48 days. Early return was experienced as stressful by ±20% of the patients. Fatigue and pain were low (respectively: simple numerical scale [SNS] = 4.2 ± 3.2 and 2.5 ± 2.9). When present, pain was relieved by the prescribed treatment. One-third of the patients described some difficulty in feeding. Fifty percent of the patients felt completely autonomous when returned at home, 80% attributed the rapid recovery of autonomy to the ERP. Finally, 87% were globally satisfied (SNS: 8.5 ± 1.0). The characteristics of the 'elderly' group (77 ± 6 years) and their questionnaire responses were similar to those of the younger patients. CONCLUSIONS Despite some limitations (retrospective, different time between surgery and the telephone survey), our study suggests that quality of life at home after ERP for colorectal surgery is very satisfactory for over 80% of patients. Furthermore, this study confirms that elderly patients benefit from an ERP for colorectal surgery like younger patients.
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Affiliation(s)
- Aurélien Partoune
- Department of anaesthesia reanimation, CHU Liège, domaine du Sart Tilman, University of Liège, Liège, Belgium
| | - Carla Coimbra
- Service of digestive surgery, CHU Liège, domaine du Sart Tilman, University of Liège, Liège, Belgium
- GRACE (Groupe francophone de Réhabilitation Après ChirurgiE), Baumont, France
| | - Jean-François Brichant
- Department of anaesthesia reanimation, CHU Liège, domaine du Sart Tilman, University of Liège, Liège, Belgium
| | - Jean Joris
- Department of anaesthesia reanimation, CHU Liège, domaine du Sart Tilman, University of Liège, Liège, Belgium
- GRACE (Groupe francophone de Réhabilitation Après ChirurgiE), Baumont, France
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Optimal Nutrition and Hydration Through the Surgical Treatment Trajectory. Semin Oncol Nurs 2017; 33:61-73. [PMID: 28062328 DOI: 10.1016/j.soncn.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To review oncology nurses role of informational continuity in regards to nutrition and hydration to ensure continuity of care from one care center to another. DATA SOURCES Peer-reviewed literature, PubMed, CINAHL, EMBASE, and web-based resources. CONCLUSION Optimal nutrition and hydration during cancer treatment and survivorship requires assessment and preplanning of needs. Oncology nurses play a vital role in preparing patients and caregivers for optimal nutrition during the surgical treatment trajectory. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses should emphasize nutrition planning during the surgical treatment trajectory to enhance survivorship and quality of life of the cancer patient. Educational resources exist for both nursing and cancer patients.
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Gillis C, Loiselle SE, Fiore JF, Awasthi R, Wykes L, Liberman AS, Stein B, Charlebois P, Carli F. Prehabilitation with Whey Protein Supplementation on Perioperative Functional Exercise Capacity in Patients Undergoing Colorectal Resection for Cancer: A Pilot Double-Blinded Randomized Placebo-Controlled Trial. J Acad Nutr Diet 2016. [DOI: 10.1016/j.jand.2015.06.007] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Abstract
Surgery represents a major stressor that disrupts homeostasis and can lead to loss of body cell mass. Integrated, multidisciplinary medical strategies, including enhanced recovery programs and perioperative nutrition support, can mitigate the surgically induced metabolic response, promoting optimal patient recovery following major surgery. Clinical therapies should identify those who are poorly nourished before surgery and aim to attenuate catabolism while preserving the processes that promote recovery and immunoprotection after surgery. This review will address the impact of surgery on intermediary metabolism and describe the clinical consequences that ensue. It will also focus on the role of perioperative nutrition, including preoperative nutrition risk, carbohydrate loading, and early initiation of oral feeding (centered on macronutrients) in modulating surgical stress, as well as highlight the contribution of the anesthesiologist to nutritional care. Emerging therapeutic concepts such as preoperative glycemic control and prehabilitation will be discussed.
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