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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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2
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Tan SHS, Elshikhawoda MSM, Jararaa S, Cheung CP, Jararah H. Preoperative Snack Prescription: A Single-Centre Experience in Optimising Preoperative Fasting Time and Enhancing Guideline Adherence. Cureus 2023; 15:e46271. [PMID: 37908906 PMCID: PMC10615353 DOI: 10.7759/cureus.46271] [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: 09/30/2023] [Indexed: 11/02/2023] Open
Abstract
Objectives Preoperative fasting plays a pivotal role in adequately preparing patients for anaesthesia and surgical procedures. However, it is imperative to consider not only the medical aspects but also patients' overall comfort, as this can significantly contribute to improved surgical outcome. The primary objective of this quality improvement project (QIP) is to provide healthcare professionals, including anaesthetists, surgeons, nurses, and stakeholders with information regarding insights required to embrace the concept of preoperative snack prescription as a strategy for enhancing patient-centred care. Methods This QIP was conducted in the vascular surgery department of a district general hospital in Wales, United Kingdom. A prospective analysis was conducted in two cycles, i.e., the pre-intervention group (PrIG) and post-intervention group (PoIG), with preoperative snacks such as biscuits, chips, or cakes, being prescribed to the PoIG. A total of 40 patients who met the inclusion criteria were enrolled in this study, with 20 patients participating in each cycle. The timing of preoperative meals, i.e., the closest preoperative breakfast, lunch, or dinner, preoperative snacks (for the PoIG), anaesthesia commencement, and surgical commencement were collected. Data analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), in conjunction with Microsoft Excel (Microsoft Corporation, Redmond, Washington, United States). Results In our QIP, the PrIG and PoIG comprised 40% (8 out of 20) and 35% (7 out of 20) female patients, respectively, with mean ages of 74 years (range, 61-86 years) and 61.3 years (range, 36-81 years). Within the PrIG, the mean duration from the preoperative meal to anaesthesia and surgery commencement was 17.8 hours (range, 14.6-22.5 hours) and 18.5 hours (range, 16.0-23.3 hours), respectively. In the PoIG, following the initiation of preoperative snack prescription, the mean time intervals between preoperative snack prescription and anaesthesia and surgery commencement were 10.9 hours (range, 6.5-16.0 hours) and 12.0 hours (range, 7.5-16.5 hours), respectively. Conclusions In summary, our QIP has successfully integrated preoperative snack prescription into the local hospital's preoperative care policy, prioritising the balance between patient safety and comfort. Based on our single-centre experience, we observed a significant reduction in the time interval between preoperative fasting and the initiation of anaesthesia, decreasing from 18.3 hours to 10.9 hours post-implementation of preoperative snacks. This QIP holds relevance for healthcare professionals as it underscores the benefits of shorter fasting periods, which contribute to heightened patient satisfaction and comfort.
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Affiliation(s)
- Steven H S Tan
- Trauma and Orthopaedics, University Hospital Llandough, Penarth, GBR
- Vascular Surgery, Glan Clwyd Hospital, Rhyl, GBR
| | | | | | - Che-Pin Cheung
- Trauma and Orthopaedics, Bronglais Hospital, Aberystwyth, GBR
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Oliveira CBD, Garcia AKA, Nascimento LAD, Conchon MF, Furuya RK, Rodrigues R, Fonseca LF. Effects of carbohydrate use on preoperative thirst: a randomized clinical trial. Rev Bras Enferm 2022; 75:e20210355. [PMID: 35894410 DOI: 10.1590/0034-7167-2021-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to evaluate the effectiveness of carbohydrate popsicles, carbohydrate solution, and usual care (fasting) on the intensity and discomfort of preoperative thirst. METHODS a randomized clinical trial with 60 preoperative patients aged between 18 and 60 years, randomized into three groups: control (fasting), carbohydrate solution (100 ml), and carbohydrate popsicle (100 ml). The outcomes were thirst intensity and discomfort. RESULTS there was a difference between groups for final thirst intensity (p = 0.01) and final thirst discomfort (p = 0.001). The effect size for both the Solution Group and the Popsicle Group was robust: 0.99 and 1.14, respectively. CONCLUSIONS the groups that received the carbohydrate fasting abbreviation showed a reduction in thirst discomfort compared to the control group. The carbohydrate popsicle proved more effective in reducing the intensity of thirst. NCT: 3.209.283.
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Sun ZJ, Sun X, Huo Y, Mi M, Peng GL, Zhang CL, Jiang Y, Zhou Y, Zhao X, Li T, Wu XB. Abbreviated perioperative fasting management for elective fresh fracture surgery: guideline adherence analysis. BMC Musculoskelet Disord 2022; 23:688. [PMID: 35858882 PMCID: PMC9297612 DOI: 10.1186/s12891-022-05574-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Long-term fasting for elective surgery has been proven unnecessary based on established guidelines. Instead, preoperative carbohydrate loading 2 h before surgery and recommencing oral nutrition intake as soon as possible after surgery is recommended. This study was performed to analyze the compliance with and effect of abbreviated perioperative fasting management in patients undergoing surgical repair of fresh fractures based on current guidelines. METHODS Patients with fresh fractures were retrospectively analyzed from the prospectively collected database about perioperative managements based on enhanced recovery of surgery (ERAS) from May 2019 to July 2019 at our hospital. A carbohydrate-enriched beverage was recommended up to 2 h before surgery for all surgical patients except those with contraindications. Postoperatively, oral clear liquids were allowed once the patients had regained full consciousness, and solid food was allowed 1 to 2 h later according to the patients' willingness. The perioperative fasting time was recorded and the patients' subjective comfort with respect to thirst and hunger was assessed using an interview-assisted questionnaire. RESULTS In total, 306 patients were enrolled in this study. The compliance rate of preoperative carbohydrate loading was 71.6%, and 93.5% of patients began ingestion of oral liquids within 2 h after surgery. The median (interquartile range) preoperative fasting time for liquids and solids was 8 (5.2-12.9) and 19 (15.7-22) hours, respectively. The median postoperative fasting time for liquids and solids was 1 (0.5-1.9) and 2.8 (2.2-3.5) hours, respectively. A total of 70.3% and 74.2% of patients reported no thirst and hunger during the perioperative period, respectively. Logistic regression analysis showed that the preoperative fasting time for liquids was an independent risk factor for perioperative hunger. No risk factor was identified for perioperative thirst. No adverse events such as aspiration pneumonia or gastroesophageal reflux were observed. CONCLUSIONS In this study of a real clinical practice setting, abbreviated perioperative fasting management was carried out with high compliance in patients with fresh fractures. The preoperative fasting time should be further shortened to further improve patients' subjective comfort.
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Affiliation(s)
- Zhi-Jian Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xu Sun
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yan Huo
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Meng Mi
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Gui-Ling Peng
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Chun-Ling Zhang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yao Jiang
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Yan Zhou
- Department of Anesthesiology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Xia Zhao
- Department of Nutriology, Beijing Jishuitan Hospital, Beijing, 100035, China
| | - Ting Li
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China.
| | - Xin-Bao Wu
- Department of Orthopedic Trauma, Beijing Jishuitan Hospital, Beijing, 100035, China
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Yimer AH, Haddis L, Abrar M, Seid AM. Adherence to pre-operative fasting guidelines and associated factors among pediatric surgical patients in selected public referral hospitals, Addis Ababa, Ethiopia: Cross sectional study. Ann Med Surg (Lond) 2022; 78:103813. [PMID: 35734657 PMCID: PMC9207049 DOI: 10.1016/j.amsu.2022.103813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/14/2022] [Accepted: 05/14/2022] [Indexed: 11/28/2022] Open
Abstract
Background Fasting before anesthesia is mandatory in children to reduce the complications of regurgitation, vomiting, and aspiration during anesthesia and surgery. Prolonged fasting times have several negative implications in children, because high fluid turnover quickly leads to dehydration, hypotension, metabolic disturbances, and hypoglycemia, resulting in poor anesthetic outcomes. Aims This study aimed to assess adherence to preoperative fasting guidelines and associated factors among pediatric patients undergoing elective surgery in Addis Ababa public hospitals in Ethiopia in 2020. Methods A cross-sectional survey was conducted in Addis Ababa, which selected public hospitals in Ethiopia, in 2020. A total of 279 pediatric patients aged <17 years scheduled for elective surgery were included in the study. Data analysis was performed using SPSS V.21, and the values of the variables and factors were checked for associations using logistic regression. Statistical significance was determined at P -value of <0.05. The results are presented in text, tables, charts, and graphs. Results A total of 279 pediatric patients responded to the analysis, with a 98.6% response rate. The majority of the participants (n = 251, 89.96%) did not follow the guidelines for preoperative fasting. The mean fasting time for clear liquids was 10 ± 4.03 (2-18 h) for breast milk 7.18 ± 2.26 (3.5-12 h), and for solid foods 13.5 ± 2.76 (8-19 h). The reasons for which the preoperative fasting delay was due to incorrect order were 35.1%, prior case procedures took longer times 34.1%, and changing sequence of schedule was 20.8%. Conclusion Most children had prolonged fasting. The staff's instructions and schedules were challenged to follow international fasting guidelines.
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Affiliation(s)
- Aragaw Hamza Yimer
- Department of Anesthesia, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Lidya Haddis
- Department of Anesthesia, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Meron Abrar
- Department of Anesthesia, School of Medicine, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmed Muhye Seid
- School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Tofani V, Milhorini CR, Paladini GM, Gaspar LO, Garcia AKA, Pierotti I, Conchon MF, Nakaya TG, Nascimento LAD, Fonseca LF. Jejum pós-operatório prolongado. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: analisar o tempo de jejum e tipo de dieta prescrita para reintrodução alimentar no pós-operatório de diferentes especialidades cirúrgicas. Método: estudo quantitativo, retrospectivo, documental e descritivo dos prontuários de pacientes cirúrgicos, com amostra randomizada e estratificada de 464 pacientes, realizado em hospital universitário público de grande porte no Paraná. Realizou-se análise estatística descritiva, apresentando medidas de tendência central e seus intervalos de confiança. Resultados: a média de jejum pós-operatório foi de 9:54h (DP: 6:89), variando de 8 a 30 horas. As clínicas que apresentaram maior tempo de jejum foram cirurgia cardíaca, cirurgia torácica e neurocirurgia, com médias de 18:25h, 14:45h e 12:22h, respectivamente. Quanto à prescrição de dieta no pós-operatório imediato, 51,3% dos pacientes receberam dieta geral, 15,3% dieta leve e 11,9% mantiveram jejum nas primeiras 24 horas após o procedimento cirúrgico. Conclusão: o tempo de jejum encontrado nessa instituição excede as atuais recomendações de protocolos nacionais e internacionais, o que implica aumento de desconfortos para o paciente cirúrgico, como sede, fome e estresse, além da insatisfação com o serviço prestado pela equipe de saúde.
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Oliveira CBD, Garcia AKA, Nascimento LAD, Conchon MF, Furuya RK, Rodrigues R, Fonseca LF. Efeitos da utilização do carboidrato sobre a sede no pré-operatório: ensaio clínico randomizado. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0355pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: avaliar a efetividade do picolé de carboidrato, solução de carboidrato e cuidado usual (jejum) sobre a intensidade e desconforto da sede no pré-operatório. Métodos: ensaio clínico randomizado, com 60 pacientes no pré-operatório, idade entre 18 e 60 anos, aleatorizados em três grupos: controle (jejum); solução de carboidrato (100 ml); picolé de carboidrato (100 ml). Os desfechos foram a intensidade e o desconforto da sede. Resultados: houve diferença entre os grupos quanto à intensidade final da sede (p = 0,01) e ao desconforto final da sede (p = 0,001). O tamanho do efeito tanto para o Grupo Solução quanto para o Grupo Picolé foi forte: 0,99 e 1,14, respectivamente. Conclusões: os grupos que receberam a abreviação do jejum com carboidrato apresentaram redução no desconforto da sede quando comparados ao grupo-controle. O picolé de carboidrato mostrou-se mais efetivo na redução da intensidade da sede. NCT: 3.209.283
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Witt L, Lehmann B, Sümpelmann R, Dennhardt N, Beck CE. Quality-improvement project to reduce actual fasting times for fluids and solids before induction of anaesthesia. BMC Anesthesiol 2021; 21:254. [PMID: 34702191 PMCID: PMC8547037 DOI: 10.1186/s12871-021-01468-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 10/07/2021] [Indexed: 12/21/2022] Open
Abstract
Background Despite well-defined recommendations, prolonged fasting times for clear fluids and solids are still common before elective surgery in adults. Extended fasting times may lead to discomfort, thirst, hunger and physiological dysfunctions. Previous studies have shown that prolonged fasting times are frequently caused by patients being misinformed as well as inadequate implementation of the current guidelines by medical staff. This study aimed to explore how long elective surgery patients fast in a German secondary care hospital before and after the introduction of an educational note for patients and re-training for the medical staff. Methods A total of 1002 patients were enrolled in this prospective, non-randomised interventional study. According to the power calculation, in the first part of the study actual fasting times for clear fluids and solids were documented in 502 consecutive patients, verbally instructed as usual regarding the recommended fasting times for clear fluids (2 h) and solids (6 h). Subsequently, we implemented additionally to the verbal instruction a written educational note for the patients, including the recommended fasting times. Furthermore, the medical staff was re-trained regarding the fasting times using emails, newsletters and employee meetings. Thereafter, another 500 patients were included in the study. We hypothesised, that after these quality improvement procedures, actual fasting times for clear fluids and solids would be more accurate on time. Results Actual fasting times for clear fluids were in the median 11.3 (interquartile range 6.8–14.3; range 1.5–25.5) h pre-intervention, and were significantly reduced to 5.0 (3.0–7.2; 1.5–19.8) h after the intervention (median difference (95%CI) − 5.5 (− 6.0 to − 5.0) h). The actual fasting times for solids also decreased significantly, but only from 14.5 (12.1–17.2; 5.4–48.0) h to 14.0 (12.0–16.3; 5.4–32.0) h after the interventions (median difference (95%CI) − 0.52 (− 1.0 to − 0.07) h). Conclusions The study showed considerably extended actual fasting times in elective adult surgical patients, which were significantly reduced by simple educational/training interventions. However, the actual fasting times still remained considerably longer than defined in recommended guidelines, meaning further process optimisations like obligatory fluid intake in the early morning are necessary to improve patient comfort and safety in future. Trial registration German registry of clinical studies (DRKS-ID: DRKS 00020530, retrospectively registered).
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Affiliation(s)
- Lars Witt
- Clinic of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.,Clinic of Anaesthesiology, KRH Klinikum Robert Koch, Gehrden, Germany
| | - Barbara Lehmann
- Clinic of Anaesthesiology, KRH Klinikum Robert Koch, Gehrden, Germany
| | - Robert Sümpelmann
- Clinic of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Nils Dennhardt
- Clinic of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany
| | - Christiane E Beck
- Clinic of Anaesthesiology, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
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Nascimento LAD, Garcia AKA, Conchon MF, Lopes MVDO, Fonseca LF. Concept analysis of Perioperative Thirst for the development of a new nursing diagnosis. Rev Bras Enferm 2021; 74:e20200065. [PMID: 33681954 DOI: 10.1590/0034-7167-2020-0065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze the perioperative thirst concept for the development of a new diagnostic structure according to NANDA International. METHODS a concept analysis study based on the framework proposed by Walker and Avant, instrumentalized through an integrative literature review based on SCOPUS, CINAHL, PUBMED, LILACS, and WOS. The elaboration of the diagnostic structure followed NANDA International guidelines. RESULTS 41 studies were analyzed revealing that perioperative thirst is prevalent and intense, having visceral and behavioral attributes as the core of the concept. Antecedents indicate that surgical patients are vulnerable to thirst; and consequents 16 signs and symptoms were organized and model cases were developed. A diagnostic structure has been developed for perioperative thirst. FINAL CONSIDERATIONS concept analysis allowed language standardization that describes thirsty patients, helping the identification, planning of actions and communication of perioperative nursing care.
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Nasir F, Hyder Z, Kasraianfard A, Sharifi A, Khamneh AC, Zarghami SY, Jafarian A. Enhanced recovery after hepatopancreaticobiliary surgery: A single-center case control study. Ann Hepatobiliary Pancreat Surg 2021; 25:97-101. [PMID: 33649261 PMCID: PMC7952678 DOI: 10.14701/ahbps.2021.25.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims The aim of this study was to find the safety and effectiveness of enhanced recovery after surgery (ERAS) in patients who undergo hepatopancreaticobiliary (HPB) surgeries and its association with the postoperative complications and survival rate of the patients. Methods This study was conducted on patients who underwent HPB surgeries in Imam Khomeini Hospital Complex, Iran from 2018 to 2020. Patients who underwent surgery after from 2019 to February 2020 considered as the ERAS group (n=47) in which ERAS was implemented postoperatively including removing nasogastric tube and initiating surgical diet at 6 hours post operation, and removing intraabdominal drains and Foley catheter at postoperative day one. Other patients (n=43) were considered as the control group in which conventional postoperative care was implemented. Results Ninety patients with the mean age of 47.3±13.3 yrs/old (range= 17-76) including 39 females were enrolled into the study. There were no significant differences between the demographic and preoperative comorbidities between the two groups. Pain severity of the patients in the ERAS group was significantly lower than the control group (visual analogue scales of 3.4±0.77 vs. 4.47±0.88, p<0.001). However, there were no significant differences between the other postoperative data between the two groups. One patient in each group died during hospitalization period due to myocardial infarction. Conclusions ERAS may be safe and effective in patients who undergo HPB surgery and may be associated with less severe postoperative pain.
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Affiliation(s)
- Fakhar Nasir
- Liver Transplant and Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeeshan Hyder
- Liver Transplant and Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasraianfard
- Liver Transplant and Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sharifi
- Department of General Surgery, Hamedan University of Medical Sciences, Hamedan, Iran
| | - Abdolhamid Chavoshi Khamneh
- Liver Transplant and Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Yahya Zarghami
- Liver Transplant and Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Liver Transplant and Research Center, Imam Khomeni Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Conchon MF, Fonseca LF, Galvão CM. Use of Mentholated Popsicle in the Management of the Elderly Patient's Thirst in the Immediate Postoperative Period: A Randomized Controlled Trial. J Perianesth Nurs 2021; 36:262-267. [PMID: 33640289 DOI: 10.1016/j.jopan.2020.09.013] [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: 06/23/2020] [Revised: 09/02/2020] [Accepted: 09/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aimed to compare a mentholated popsicle with usual care (absolute fasting) in the change in thirst intensity and discomfort in elderly patients in the immediate postoperative period (IPP). DESIGN A randomized controlled trial. METHODS The sample consisted of 50 elderly patients (60 years or older) in the IPP who were randomly assigned to two groups: experimental group (20 mL mentholated popsicle) and control group (usual care). The outcomes, thirst intensity and discomfort, were assessed at baseline and 20 minutes after the intervention. FINDINGS The mentholated popsicle presented a statistically significant (P < .001) decrease in thirst intensity and discomfort by 5.0 in the median and a Cohen's r large effect size for both outcomes. There were no adverse events or side effects. CONCLUSIONS The use of a mentholated popsicle decreased the intensity and discomfort of the elderly patient's thirst in the IPP.
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Affiliation(s)
| | | | - Cristina M Galvão
- Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
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Morgan KL, Levin AI, Esterhuizen TM. The incidence of maternal hypoglycaemia with prolonged fasting before elective caesarean section. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.2585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- KL Morgan
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town,
South Africa
| | - AI Levin
- Department of Anaesthesiology and Critical Care, Stellenbosch University,
South Africa
| | - TM Esterhuizen
- Division of Epidemiology and Biostatistics, Stellenbosch University,
South Africa
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Nascimento LAD, Garcia AKA, Conchon MF, Aroni P, Pierotti I, Martins PR, Nakaya TG, Fonseca LF. Advances in the Management of Perioperative Patients' Thirst. AORN J 2020; 111:165-179. [DOI: 10.1002/aorn.12931] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Aroni P, Fonseca LF, Ciol MA, Margatho AS, Galvão CM. The use of mentholated popsicle to reduce thirst during preoperative fasting: A randomised controlled trial. J Clin Nurs 2019; 29:840-851. [DOI: 10.1111/jocn.15138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/17/2019] [Accepted: 11/19/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Patricia Aroni
- Department of Nursing State University of Londrina Londrina Brazil
| | - Ligia F. Fonseca
- Department of Nursing State University of Londrina Londrina Brazil
| | - Marcia A. Ciol
- Department of Rehabilitation Medicine School of Medicine University of Washington Seattle WA USA
| | - Amanda S. Margatho
- General and Specialized Nursing Department Ribeirão Preto College of Nursing University of São Paulo Ribeirão Preto Brazil
| | - Cristina M. Galvão
- General and Specialized Nursing Department Ribeirão Preto College of Nursing University of São Paulo Ribeirão Preto Brazil
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Costa DAPD, Guerra JG, Goldman SM, Kemp R, Santos JS, Ardengh JC, Ribas CAPM, Nassif PAN, Ribas-Filho JM. MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) VERSUS ENDOSONOGRAPHY-GUIDED FINE NEEDLE ASPIRATION (EUS-FNA) FOR DIAGNOSIS AND FOLLOW-UP OF PANCREATIC INTRADUCTAL PAPILLARY MUCINOUS NEOPLASMS. ACTA ACUST UNITED AC 2019; 32:e1471. [PMID: 31859924 PMCID: PMC6918736 DOI: 10.1590/0102-672020190001e1471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/09/2019] [Indexed: 12/31/2022]
Abstract
Background: Intraductal papillary mucinous tumor (IPMN) are being diagnosed with increasing frequency. Computerized tomography scanning is commonly used as the primary imaging modality before surgery nonetheless magnetic resonance cholangiopancreatography (MRCP) provides better characterization. Endosonography-guided fine needle aspiration (EUS-FNA) has emerged as a way to reach pathological diagnose. Aim: To compare results of both methods with surgical pathology findings for classification of IPMN. Methods: Thirty-six patients submitted to surgical resection with preoperative suspect of IPMN were submitted preoperatively to MRCP and EUS-FNA. Images obtained were analyzed according to a classification determined for each method. ROC curve was used for statistical analysis, that compared the images tests with the purpose of finding the best method for diagnosis and classification of IPMN. Results: Sixteen patients underwent pancreatoduodenectomy, 16 to subtotal pancreatectomy and only four laparotomy. Pathological diagnosis was IPMN (n=33) and pancreatic intraepithelial neoplasia type 2 (n=3). Twenty-nine revealed non-invasive neoplasia and invasive form in four patients. MRCP and EUS-FNA have correctly diagnosed and classified (type of IPMN), in 62.5% and 83.3% (p=0.811), the affected segment location in 69% and 92% (p=0.638) and identification of nodules and/or vegetation presence in 45% and 90% (p=0.5). Regarding to histopathological diagnosis by EUS-FNA the sensitivity was 83.3%; specificity was 100%; positive predictive value was 100%; negative predictive value was 33.3% and accuracy was 91.7%. Conclusions: There was no significant difference in the diagnosis of IPMN. However, EUS-FNA showed better absolute results than MRCP to identify nodule and/or vegetation.
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Affiliation(s)
| | - João Guilherme Guerra
- AC Camargo Cancer Center, Endoscopy Service, AC Camargo Hospital, São Paulo, SP, Brazil
| | - Suzan Menasce Goldman
- Department of Diagnostic Imaging, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Rafael Kemp
- Department of Surgery and Anatomy, Hospital das Clínicas, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - José Sebastião Santos
- Department of Surgery and Anatomy, Hospital das Clínicas, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
| | - José Celso Ardengh
- Department of Diagnostic Imaging, Paulista School of Medicine, Federal University of São Paulo, São Paulo, SP, Brazil.,Department of Surgery and Anatomy, Hospital das Clínicas, Ribeirão Preto Medical School, Ribeirão Preto, SP, Brazil
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Araripe TSDO, Aguiar APN, Alexandrino RKC, Maia FMM, Mendonça PDS. Impacto do estado nutricional e do tempo de jejum nas complicações gastrointestinais e no tempo de hospitalização em pacientes cirúrgicos. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2019.v45.25664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introdução: O estado nutricional e o tempo de jejum pré e pós-cirúrgico impactam na morbimortalidade de pacientes submetidos a cirurgias eletivas. No Brasil, o tempo de jejum prolongado e a elevada prevalência de desnutrição são comuns nos hospitais terciários. Objetivo: Realizar levantamento do tempo de jejum médio praticado em hospital terciário e avaliar o impacto do jejum pré e pós-cirúrgico e do estado nutricional nas complicações gastrointestinais imediatas e no tempo de hospitalização em pacientes cirúrgicos. Material e métodos: Estudo prospectivo, realizado no Hospital Universitário Walter Cantídio, em Fortaleza. Foram avaliados 173 indivíduos submetidos a cirurgias eletivas de médio e grande porte entre agosto de 2016 a janeiro de 2017. Foram coletadas medidas antropométricas, hemograma e informações como tempo de jejum pré e pós-cirúrgico, permanência hospitalar e complicações gastrointestinais. As análises de correlação e associação foram realizadas no Software SPSS®, com nível de significância fixado em p< 0,05. Resultados: A maioria dos pacientes (71,1%) foi submetida à cirurgia de porte II (grande porte). Houve correlação negativa entre tempo de permanência hospitalar e índice de massa corporal [r= -0,223; p= 0,003], circunferência braquial [r= -0,335; p< 0,001], dobra cutânea tricipital [r= -0,320; p< 0,001], área muscular do braço corrigida [r= -0,253; p= 0,001], contagem total de linfócitos [r= -0,223; p= 0,008], hemoglobina [r= -0,243; p= 0,004] e relação linfócito/monócito [r= -0,308; p< 0,001]. Adicionalmente, houve correlação positiva entre tempo de permanência hospitalar com o tempo de jejum pós-cirúrgico [r= 0,456; p< 0,001]. Ausência de complicações gastrointestinais foi associada a valores de triagem (Nutritional Risk Screenin-2002) < 3 (p= 0,034) e entre menor tempo de jejum pós-cirúrgico (p= 0,033). Conclusão: Pacientes desnutridos, com maior risco nutricional e os que se submeteram a um tempo de jejum pós-cirúrgico elevado apresentaram maior tempo de permanência hospitalar e maior incidência de complicações gastrointestinais.
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Teixeira UF, Goldoni MB, Waechter FL, Sampaio JA, Mendes FF, Fontes PRO. ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER. ACTA ACUST UNITED AC 2019; 32:e1424. [PMID: 30758472 PMCID: PMC6368150 DOI: 10.1590/0102-672020180001e1424] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. AIM To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. METHODS Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. RESULTS There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. CONCLUSION Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.
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Affiliation(s)
| | | | | | | | - Florentino Fernandes Mendes
- Department of Anesthesiology, Federal University of Health Sciences of Porto Alegre / Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil
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Campos SBG, Barros-Neto JA, Guedes GDS, Moura FA. PRE-OPERATIVE FASTING: WHY ABBREVIATE? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1377. [PMID: 29972405 PMCID: PMC6044196 DOI: 10.1590/0102-672020180001e1377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/29/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Considering the practice of preoperative fasting based on observations on the gastric emptying delay after induction and the time of this fast is closely linked to organic response to trauma, arise the question about preoperative fasting period necessary to minimize such response and support the professional with clinical and scientific evidence. AIM To review the aspects related to the abbreviation of preoperative fasting from the metabolic point of view, physiology of gastric emptying, its clinical benefits and the currently recommendations. METHOD Literature review was based on articles and guidelines published in English and Portuguese, without restriction of time until January 2017, in PubMed, SciELO and Cochrane with the descriptors: surgery, preoperative fasting, carbohydrate. From the universe consulted, 31 articles were selected. RESULTS The literature suggests that the abbreviation of fasting with beverage added carbohydrates until 2 h before surgery, can bring benefits on glycemic and functional parameters, reduces hospitalization, and does not present aspiration risk of healthy patients undergoing elective surgery. Another nutrient that has been added to the carbohydrate solution and has shown promising results is glutamine. CONCLUSION The abbreviation of preoperative fasting with enriched beverage with carbohydrates or carbohydrate and glutamine seems to be effective in the care of the surgical patient, optimizing the recovery from of postoperative period.
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Carvalho CALDB, Carvalho AAD, Nogueira PLB, Aguilar-Nascimento JED. CHANGING PARADIGMS IN PREOPERATIVE FASTING: RESULTS OF A JOINT EFFORT IN PEDIATRIC SURGERY. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:7-10. [PMID: 28489159 PMCID: PMC5424677 DOI: 10.1590/0102-6720201700010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/17/2017] [Indexed: 12/23/2022]
Abstract
Background: Current researches associate long fasting periods to several adverse consequences. The fasting abbreviation to 2 h to clear liquids associated with the use of drinks containing carbohydrates attenuates endocrinometabolic response to surgical trauma, but often is observed children advised to not intake food from 00:00 h till the scheduled surgical time, regardless of what it is. Aim: To evaluate the safety of a protocol of preoperative fasting abbreviation with a beverage containing carbohydrates, and early postoperative feeding in children underwent elective small/mid-size surgical procedures during a national task-force on pediatric surgery. Methods: Thirty-six patients were prospectively included, and for several reasons five were excluded. All 31 who remained in the study received a nutritional supplement containing 150 ml of water plus 12.5% maltodextrin 2 h before the procedure. Data of the pre-operative fasting time, anesthetic complications and time of postoperative refeeding, were collected. Results: Twenty-three (74.2%) were males, the median age was 5 y, and the median weight was 20 kg. The median time of pre-operative fasting was 145 min and the time of post-operative refeeding was 135 min. There were no adverse effects on the anesthetic procedures or during surgery. Post-operatively, two children (6.5%) vomited. Conclusion: The abbreviation of pre-operative fasting to 2 h with beverage containing carbohydrate in pediatric surgery is safe. Early refeeding in elective small/mid-size procedures can be prescribed. Racional: Trabalhos atuais associam longos períodos de jejum com diversas consequências adversas. A abreviação do jejum de 2 h para líquidos claros associado ao uso de bebidas contendo carboidratos atenua resposta endocrinometabólica ao trauma, porém frequentemente as crianças são orientadas a não ingerir alimentos a partir das 00:00 h do dia anterior à operação, independente do horário do procedimento cirúrgico. Objetivo: Avaliar a segurança de um protocolo de abreviação do jejum pré-operatório, com o uso de bebida contendo carboidratos, e realimentação precoce. Métodos: Foram avaliados prospectivamente 36 crianças submetidas a procedimentos cirúrgicos eletivos de pequeno e médio porte. Cinco foram posteriormente excluídos do estudo. Todos os 31 remanescentes receberam suplemento nutricional com maltodextrina 12,5% em 150 ml de água aproximadamente 2 h antes do procedimento. Foram coletados dados do tempo de jejum pré-operatório, complicações anestésicas e tempo de realimentação. Resultados: Vinte e três (74,2%) eram do gênero masculino, com idade mediana de cinco anos e peso mediano de 20 kg. O tempo mediano de jejum pré-operatório foi de 145 min e o tempo mediano para realimentação foi de 135 min. Não houve eventos adversos durante a anestesia ou operação. No período pós-operatório, duas (6,5%) crianças vomitaram. Conclusão: A abreviação de jejum pré-operatório para 2 h com uso de bebida contendo carboidratos, em operações eletivas de crianças, é seguro e não está associado ao maior risco de broncoaspiração pulmonar. Realimentação precoce pode ser prescrita nos procedimentos cirúrgicos analisados.
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Garcia AKA, Fonseca LF, Aroni P, Galvão CM. Strategies for thirst relief: integrative literature review. Rev Bras Enferm 2017; 69:1215-1222. [PMID: 27925100 DOI: 10.1590/0034-7167-2016-0317] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: to analyze the strategies used to relieve the thirst of hospitalized patients. Method: an integrative review, for which the databases PubMed, LILACS, CINAHL and the group of references organized by the Group for Study and Research of Thirst were selected for the search of primary studies, with the keywords: thirst, ice, cold, intervention, nursing care, artificial saliva. Results: the review sample was composed of ten primary studies. The strategies found were: low temperature using frozen gauze, ice chips, and cold water, menthol associated with cold strategies, chewing gum, acupressure, and the use of a thin straw, substitute saliva, and early fluid ingestion. Conclusion: the temperature was presented as a predominant and effective strategy to relieve the thirst for surgical patients in intensive care and hemodialysis treatment.
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Affiliation(s)
- Aline Korki Arrabal Garcia
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Londrina-PR, Brasil
| | - Lígia Fahl Fonseca
- Universidade Estadual de Londrina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Enfermagem. Londrina-PR, Brasil
| | - Patricia Aroni
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental. Ribeirão Preto-SP, Brasil
| | - Cristina Maria Galvão
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Pós-Graduação em Enfermagem Fundamental. Ribeirão Preto-SP, Brasil
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Mambou Tebou CG, Temgoua MN, Esiene A, Nana BO, Noubiap JJ, Sobngwi E. Impact of perioperative nutritional status on the outcome of abdominal surgery in a sub-Saharan Africa setting. BMC Res Notes 2017; 10:484. [PMID: 28923097 PMCID: PMC5604173 DOI: 10.1186/s13104-017-2765-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 08/31/2017] [Indexed: 11/13/2022] Open
Abstract
Background Malnutrition is a clinical condition of multifactorial etiologies and it is associated with several adverse outcomes. In high-income countries, malnutrition has been described as a determinant of delayed wound healing, surgical site infections and mortality in the postoperative period. There is limited information available regarding the outcome of surgery in malnourished patients in sub-Saharan Africa. Methods A cross-sectional analytic study was carried out between March and August 2014 in the visceral surgery and the emergency departments of the Yaounde Central Hospital in Cameroon. All consecutive consenting preoperative and postoperative patients of abdominal surgical procedures were enrolled. Variables studied were: socio-demographic characteristics, medical and surgical past histories, nutritional survey, anthropometric parameters and serum albumin level in order to determine the nutritional risk index (or Buzby score). Results A total of 85 patients aged from 19 to 50 years with mean age of 34.4 ± 8 years were included. The most performed abdominal surgical procedure was appendectomy (30.6%). The prevalence of preoperative malnutrition according to the Buzby score was 39.1%. Mean postoperative weight lost was 2.9 ± 1.2 kg and mean decrease in postoperative serum albumin was 4.2 ± 0.2 g. A normal postoperative serum albumin was associated with a favorable outcome [OR (95% CI) = 55 (13.4–224.3), p < 0.001]. Conclusions The prevalence of malnutrition is high in our visceral surgery and emergency departments; this is associated with an increased risk of adverse early postoperative outcomes. Overall, our results emphasize the need of optimizing perioperative care through routine nutritional assessment and management of surgical patients in Cameroon. Electronic supplementary material The online version of this article (doi:10.1186/s13104-017-2765-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Mazou N Temgoua
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, P.O Box 1364, Yaoundé, Cameroon
| | - Agnès Esiene
- Anesthesiology and Intensive Care Department, Central Hospital of Yaoundé, P.O Box 87, Yaoundé, Cameroon
| | - Blondel Oumarou Nana
- National Social Insurance Fund Health Center of Yaoundé, P.O Box 5777, Yaoundé, Cameroon
| | - Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, 7925, South Africa
| | - Eugène Sobngwi
- Higher Institute of Health Sciences, Université des Montagnes, P.O Box 208, Bagangté, Cameroon. .,National Obesity Center, Central Hospital of Yaoundé, P.O Box 87, Yaoundé, Cameroon.
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Rattray M, Roberts S, Marshall A, Desbrow B. A systematic review of feeding practices among postoperative patients: is practice in-line with evidenced-based guidelines? J Hum Nutr Diet 2017; 31:151-167. [PMID: 28589624 DOI: 10.1111/jhn.12486] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early oral feeding after surgery is best practice among adult, noncritically ill patients. Evidenced-based guidelines (EBG) recommend commencing liquid and solid feeding within 24 h of surgery to improve patient (e.g. reduced morbidity) and hospital (e.g. reduced length of stay) outcomes. Whether these EBG are adhered to in usual clinical practice remains unknown. The present study aimed to identify the time to commencement of first oral feed (liquid or solid) and first solid feed among postoperative, noncritically ill, adult patients. METHODS MEDLINE, CINAHL, SCOPUS and Web of Science databases were searched from inception to June 2016 for observational studies reporting liquid and/or solid feeding practices among postoperative patients. Studies reporting a mean/median time to first feed or first solid feed within 24 h of surgery or where ≥75% of patients were feeding by postoperative day one were considered in-line with EBG. RESULTS Of 5826 articles retrieved, 29 studies were included. Only 40% and 22% of studies reported time to first feed and time to first solid feed in-line with EBG, respectively. Clear and free liquids were the first diet types commenced in 86% of studies. When solids were commenced, 44% of studies reported using various therapeutic diet types (e.g. light) prior to the commencement of a regular diet. Patients who underwent gastrointestinal procedures appeared more likely to experience delayed postoperative feeding. CONCLUSIONS Our findings demonstrate a gap between postoperative feeding evidence and its practical application. This information provides a strong rationale for interventions targeting improved nutritional care following surgery.
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Affiliation(s)
- M Rattray
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - S Roberts
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia
| | - A Marshall
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia.,National Centre of Research Excellence in Nursing (NCREN), Griffith University, Southport, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Southport, QLD, Australia
| | - B Desbrow
- School of Allied Health Sciences, Griffith University, Southport, QLD, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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