Efficacy of enteral nutritional support after hospital discharge in major gastrointestinal surgery patients: a systematic review

Abstract

Effi cacy of enteral nutritional support after hospital discharge in major gastrointestinal surgery patients: a systematic review ResumenIntroducción: el soporte nutricional en pacientes desnutridos sometidos a cirugía gastrointestinal reduce la tasa de complicaciones y acorta la duración de la estancia. En esta revisión sistemática se analiza su efi cacia después del alta hospitalaria. Métodos: la estrategia de búsqueda (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") se introdujo en las bases Medline, CENTRAL y TripDatabase. Fueron criterios de inclusión: tipo de estudio (RCT), idioma (inglés, español) y población del estudio (pacientes sometidos a cirugía gastrointestinal). El riesgo de sesgo se evaluó mediante la metodología Cochrane. Resultados: se incluyeron cinco estudios (446 pacientes), publicados en seis artículos diferentes. Se detectó un alto riesgo de sesgo en la mayoría de ellos. El soporte nutricional mejoró la ingesta de energía y el consumo de proteínas cuando se proporcionaron suplementos orales hiperproteicos. La intervención se asoció con un mejor pronóstico de peso, pero los datos sobre la composición corporal fueron inconsistentes. En la mayoría de los estudios, la intervención nutricional no mejoró la capacidad funcional o la calidad de vida. Ninguno de los estudios analizó los efectos sobre las complicaciones después del alta. Conclusión: el soporte nutricional proporcionado después del alta puede aumentar la ingesta y mejorar el peso corporal, pero la baja calidad de los estudios debilita la validez de los resultados. AbstractIntroduction: Nutritional support for malnourished patients undergoing gastrointestinal surgery reduces the complication rate and shortens the length of stay. The effi cacy of nutritional support after hospital discharge was analyzed in this systematic review. Methods: The search strategy (nutrition OR "enteral nutrition" OR "nutritional supplements" OR "oral nutritional supplements" OR "sip feed" OR "sip feeding" OR "dietary counseling") AND ("patient discharge" OR discharge OR postdischarge) AND (surgery OR operation OR "surgical procedure") was followed in Medline, CENTRAL, and Trip databases. Inclusion criteria comprised: type of study (randomized controlled trial), language (English, Spanish), and subjects (patients undergoing gastrointestinal surgery). The risk of bias was assessed by using the Cochrane methodology. Results: Five studies which were published in six different articles and recruited 446 patients were included. A high risk of bias was detected for most of them. Nutritional support improved energy intake and protein intake when high-protein oral supplements were provided. The intervention was associated with better weight prognosis, but the data about body composition were inconsistent. In most of the trials, nutritional intervention did n...

Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage

“…Preoperative poor nutritional status is related to operative risk. For example, it can increase morbidity rate in digestive surgeries [ 14 , 15 ]. Therefore, we attempted to improve nutritional status of patients by monitoring nutritional parameters.…”

“…Other nutritional parameters including serum albumin level were maintained in their normal levels. Therefore, many patients had a good nutritional status in comparison with those who underwent pancreatectomy or esophagectomy [ 4 , 6 , 14 , 18 ]. White blood cells or lymphocytes were examined in the status of released inflammation or biliary obstruction in case of biliary diseases just before hepatectomy.…”

Clinical significance of preoperative nutritional parameter and patient outcomes after pancreatectomy: A retrospective study at two academic institute

“…Preoperative poor nutritional status has been related to operative risk with respect to increased morbidity rates in digestive surgeries 121314. Therefore, we attempted to improve the nutritional status by monitoring nutritional parameters, calorie increases, and the administration of enteral nutritional products.…”

Perioperative nutrition and enhanced recovery after surgery in gastrointestinal cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition)

“…Patients at moderate or severe nutritional risk (especially those undergoing upper gastrointestinal cancer surgery) should be considered for routine postoperative nutritional support (where relevant by oral or enteral routes) and consideration should be given to extending such support when the patient is discharged into the community [28,29].…”