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Background Malnutrition is associated with high rates of postoperative morbidity and mortality. Purpose This pilot study evaluated the effectiveness of a preoperative nutritional support programme for patients who were about to undergo major elective lower gastrointestinal surgery. Materials and methods A high-calorie/high-protein enteral formula was administered perioperatively to the group of patients at nutritional risk/with malnutrition (NR/MN), who were detected with the Mini Nutritional Assessment (MNA) test, a validated nutrition screening and assessment tool that can identify patients who are malnourished or at risk of malnutrition. In order to assess the effectiveness of the preoperative nutritional intervention, we collected mortality, length of stay, re-entry, gastrointestinal complications after surgery, clinical complications (infections, sepsis, hyperglycaemia, renal failure, intestinal failure, fistula). The results were compared to a comparable (type of surgery, demographic and anthropometric data) retrospective control group. Results 63 patients were studied. Statistically significant differences were found between the prospective NR/MN supplemented group and the retrospective NR/MN non-supplemented group in: Wound infection (0% vs. 24.6%; p = 0.001), hyperglycaemia (32.6% vs. 59.6%; p = 0.001), death in hospital (4.7% vs. 14.0%; p = 0.008), length of hospital stay (9.86 days vs. 13.54; p = 0.006), time in ICU (0.55 days vs. 3.21; p = 0.037) and administration of TPN (1.67 days vs. 6.78; p = 0.000). Conclusions Postoperative progress was found to be better in the group of NR/MN patients supplemented preoperatively with an enteral nutrition formula. No conflict of interest.

Background The use of enteral nutrition (EN) has expanded as a practice of first choice in patients who are malnourished or at risk of malnutrition. Purpose To explore the practice of EN in order to identify aspects that hospital pharmacy could possibly improve. Materials and methods A six-month retrospective descriptive study (January–August 2013) was conducted in a tertiary hospital. The variables analysed were: a) refering to the patient: age, sex, medical service and length of stay (LOS) and b) related to EN: formula type, route and duration of enteral administration and daily calorific intake. Prescription data were collected from the electronic prescribing program; patient data were obtained from the electronic medical record. Results A total of 217 patients received EN during the study period, 66.2% were men, mean age 68 years (range 32–95). The mean LOS was 20 days (minimum: 1, maximum: 103). The average days with EN were 8 (minimum: 1, maximum 95). The clinical service distribution was: Internal Medicine (33.3%), Neurology (12.9%), Otorhinolaryngology (11.3%), General Surgery (9.4%), Pneumology (6.9%), Digestive (5.2%), Mental Health (5.1%), Angiology and Vascular Surgery (5.0%), Traumatology (3.1%) and others (7.7%). 89 patients (41.0%) were malnourished at the outset of feeding; the mean daily calories fed were 1,105.55 K cal/day. More than half of the enteral support was complete diets (68.5%), the rest (31.5%) were supplement diets. According to calorie-protein content four different diets were used: normoprotein-isocaloric (39.3%), high protein-isocaloric (31.9%), high protein-high calorie (19.7%) and normoprotein-high calorie (9.1%). 19.5% were special diets, including: 66.6% complete diet for diabetes, 20.5% diet with fibre, 11.7% supplement for diabetes, 0.4% complete diet for hepatic disease and 0.8% was dialysis and predialysis EN. Conclusions Commonly, these studies are conducted in an intensive care unit or in ambulatory patients, where the baselines characteristics differ from the general population in a hospital. Thus, our results were consistent with those from similar studies done by Ballesteros Cabañas GI et al. in terms of days with EN (7.5 days), majority medical service prescription (78%) and prevalence of malnutrition (43.2%). However, according to the calorie-protein content in that study a high protein-high calorie formula was the most prescribed (54.5%). This contrasts with our results in which a normoprotein-isocaloric formula was the most used (39.3%). These results support the view that the increasing availability of different brands and varieties of EN requires the creation of nutritional support groups including a pharmacist that would guide the choice of formulas, write procedures and educate teams working with EN to improve feeding practice. No conflict of interest.

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