Effect of Pre-operative Nutritional Protocol Implementation on Postoperative Outcomes Following Gastrointestinal Surgeries: A Randomized Clinical Trial

Abstract

Introduction: A significant proportion of patients undergoing major gastrointestinal operations suffer from malnutrition. Although the benefit of postoperative nutritional support is well established, the effects of energy intake during pre-operative period is less reported. The present study was designed to test the effect of structured pre-operative nutritional therapy on the postoperative recovery of patients undergoing major gastrointestinal operations. Methods: A randomized clinical trial was conducted among 80 patients of the surgical gastroenterology department of a tertiary care center in south India. A simple random sampling method was used. The nutritional status of all participants was assessed by subjective global assessment (SGA). While control group received standard energy intake nutrition, the experimental group received calculated nutrition with an extra 50 g of soy protein for seven days pre operatively. Data were analysed using SPSS version 20. Results: The median day of removal of abdominal drainage tube was 3 (0-5) compared to 5 (2.5-7.5) in the control group. In the intervention group, the median time for the appearance of bowel sounds and starting of enteral feeding was 1.1 (0.5) days and 2 (1-2) days, while in the control group, it was 1.6 (0.9) days, 3 (1-4) days, respectively which was significant at P<0.05. Similarly, the mean (SD) postoperative serum albumin on third day was 3.6 (0.4) g/dL vs 3.4 (0.4) g/dL experimental and in the control group. Conclusion: Preoperative nutrition protocol improved the patients’ clinical outcomes in terms of post-operative serum albumin, the timing of bowel sounds, and early initiation of enteral feeds.

S3-Leitlinie Klinische Ernährung in der Chirurgie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) e. V.

“…Die Anwendung von Ernährungsprotokollen und Standardarbeitsanweisungen (SOP) hat sich als vorteilhaft für die Sicherstellung der Durchführung der medizinischen Ernährung und das Erreichen des Kalorienziels gezeigt 302 303 (2+ und 1+) Eine angemessene Versorgung mit Mikronährstoffen wird als wesentlich für eine langfristige totale PE angesehen. Bhattacharyya haben randomisiert positive Auswirkungen eines präoperativen Protokolls auf das Eintreten der Darmtätigkeit und den Beginn einer EE gezeigt 304 (1-).…”

Extending the benefit of nutrition intervention beyond the operative setting

“…The implementation of nutritional intervention is directly related to postoperative clinical outcomes. Nutritional therapy for 7-14 days prior to the surgical procedure has consistently showed to improved clinical outcomes [1,7]. As such, this preoperative window of opportunity is key to prescribe nutritional therapy that can ultimately lead to better postsurgical outcomes.…”

“…As a result, the prevalence of malnutrition associated or not to sarcopenia may increase during the early postoperative period. This is commonly observed preoperatively, especially in oncological patients, and leads to an increased risk of postoperative complications, length of hospital stay (LOS), and costs [1][2][3]. Several studies have shown that the implementation of multimodal protocols of enhanced recovery is essential to reduce unfavorable postoperative outcome.…”