Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery

Martin, Lisa W.; Gillis, Chelsia; Atkins, Marlis; Gillam, M.; Sheppard, Caroline E.; Buhler, Susan; Hammond, Carlota Basualdo; Nelson, Gregg; Gramlich, Leah

doi:10.1002/jpen.1417

Cited by 40 publications

(47 citation statements)

References 40 publications

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“…As it is of utmost importance, the concept of early enteral nutrition needs to be embedded in a multimodal nutritional approach. ERP may have a positive impact on the adoption of standardized perioperative nutrition care practices, in particular by increasing detection and timely treatment of malnutrition [ 26 ]. Exercise, nutrition and anxiety reduction further complement ERP and facilitate return to baseline activities of daily living including normal nutrition [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

et al. 2018

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Early re-alimentation is advocated by enhanced recovery pathways (ERP). This study aimed to assess compliance to ERP-set early re-alimentation policy and to compare outcomes of early fed patients and patients in whom early feeding was withhold due to the independent decision making of the surgeon. For this purpose, demographic, surgical and outcome data of all consecutive elective colorectal surgical procedures (2011–2016) were retrieved from a prospectively maintained institutional ERP database. The primary endpoint was postoperative ileus (POI). Surgical 30-day outcome and length of stay were compared between patients undergoing the pathway-intended early re-alimentation pattern and patients in whom early re-alimentation was not compliant. Out of the 7103 patients included, 1241 (17.4%) were not compliant with ERP re-alimentation. Patients with delayed re-alimentation presented with more postoperative complications (37 vs. 21%, p < 0.001) and a prolonged length of hospital stay (8 ± 7 vs. 5 ± 4 days, p < 0.001). While male gender (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.04–1.32), fluid overload (OR 1.38; 95% CI 1.16–1.65) and high American Society of Anaesthesiologists (ASA) score (OR 1.51; 95% CI 1.27–1.8) were independent risk factors for POI, laparoscopy (OR 0.51; 95% CI 0.38–0.68) and ERP compliant diet (OR 0.46; 95% CI 0.36–0.6) were both protective. Hence, this study provides further evidence of the beneficial effect of early oral feeding after colorectal surgery.

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Section: Discussionmentioning

confidence: 99%

Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

et al. 2018

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“…Since their inception, ERAS protocols for 15 procedures have been published or are currently under production by the ERAS ® Society, as of 2017 1 . The principal goal of these protocols is to minimize patients' stress response by achieving the following elements: optimizing preoperative nutritional support, carbohydrate loading to minimize insulin resistance, emphasizing non-opioid analgesia and anti-inflammatory drugs, and initiating early postoperative enteral nutrition [1][2][3] . Another important component is the maintenance of euvolaemia by optimizing intraoperative and postoperative fluid administration 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Another important component is the maintenance of euvolaemia by optimizing intraoperative and postoperative fluid administration 1 . ERAS protocols typically include over 20 individual elements that require participation and cooperation among several disciplines including surgery, anaesthesia and nursing [1][2][3][4][5][6] .…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgery pathway in patients with soft tissue sarcoma

Lyu

Saadat

Bertagnolli

et al. 2020

British Journal of Surgery

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Background: Patients undergoing surgery for soft tissue sarcoma have high morbidity rates, particularly after preoperative radiation therapy (RT). An enhanced recovery after surgery (ERAS) programme may improve perioperative outcomes in abdominal surgery. This study reported outcomes of an ERAS programme tailored to patients with soft tissue sarcoma. Methods: A prospective ERAS protocol was implemented in 2015 at a high-volume sarcoma centre. Patients treated within the ERAS programme from 2015 to 2018 were case-matched retrospectively with patients treated between 2012 and 2018 without use of the protocol, matched by surgical site, surgeon, sarcoma histology and preoperative RT treatment. Postoperative outcomes, specifically wound complications and duration of hospital stay, were reported. Results: In total, 234 patients treated within the ERAS programme were matched with 237 who were not. The ERAS group had lower wound dehiscence rates overall (2 of 234 (0⋅9 per cent) versus 31 of 237 (13⋅1 per cent); P < 0⋅001), after preoperative RT (0 of 41 versus 11 of 51; P = 0⋅004) and after extremity sarcoma surgery (0 of 54 versus 6 of 56; P = 0⋅040) compared with the non-ERAS group. Rates of postoperative ileus or obstruction were lower in the ERAS group (21 of 234 (9⋅9 per cent) versus 40 of 237 (16⋅9 per cent); P = 0⋅016) and in those with retroperitoneal sarcoma (4 of 36 versus 15 of 36; P = 0⋅007). Duration of hospital stay was shorter in the ERAS group (median 5 (range 0-36) versus 6 (0-67) days; P = 0⋅003). Conclusion: Treatment within an ERAS protocol for patients with soft tissue sarcoma was associated with lower morbidity and shorter hospital stay.

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“…NATs are objective measures that help to confirm the diagnosis of malnutrition. 10,11 They can be broadly classified into one The information provided by NATs is supplemented by additional dietitian input, thus leading to an evaluation including food intake, barriers to intake and the stress associated with disease or illness in order to formulate a personalised nutritional plan. 9,12,13 Although clearly associated with prognosis, in cirrhosis, the definition of malnutrition and the processes for nutrition screening and assessment are in evolution, without a clearly accepted standard.…”

Section: Introductionmentioning

confidence: 99%

“…In patients identified to be at high‐risk, the screen is followed by a nutrition assessment incorporating nutrition assessment tools (NATs). NATs are objective measures that help to confirm the diagnosis of malnutrition . They can be broadly classified into one of four categories: (a) bedside single measure nutritional assessment tools (NATs) (ie) mid‐arm muscle circumference (MAMC), hand grip strength (HGS), etc (b) bedside global NATs (ie) subjective global assessment (SGA), Royal Free Hospital‐Global Assessment (RFH‐GA), (c) non‐cross‐sectional imaging‐based body composition assessment tools (ie) bioelectrical impedance analysis (BIA) and (d) cross‐sectional imaging‐based sarcopenia assessment (ie) L3 skeletal index via computed tomography (CT) or magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

Ney

Vandermeer

et al. 2019

Liver International

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Background & Aims Disease‐related malnutrition is common in cirrhosis. Multiple studies have evaluated nutritional screening tools (NSTs, rapid bedside tests targeting who needs assessment) and nutritional assessment tools (NATs, used in diagnosing malnutrition) as predictors of clinical outcome in this population. We performed a systematic review and meta‐analysis of this literature with the aim of summarising the varying definitions of malnutrition across studies, the available evidence for NSTs and the ability of NSTs and NATs to predict clinical outcomes in cirrhosis. Methods The primary outcome measures were pre‐ and post‐transplant mortality with a range of secondary outcomes. Inclusion: cirrhosis over age 16. Exclusion: >25% with hepatocellular carcinoma, primarily laboratory test‐based NATs or lack of screening, assessment or outcome criteria. Results Eight thousand eight hundred fifty patients were included across 47 studies. Only 3 studies assessed NSTs. Thirty‐two definitions for malnutrition were utilised across studies. NATs predicted pre‐transplant mortality in 69% of cases that were assessed with a risk ratio (RR) of 2.38 (95% CI 1.96‐2.89). NATs were prognostic for post‐transplant mortality only 28% of the times they were assessed, with a RR of 3.04 (95% CI 1.51‐6.12). Conclusions The cirrhosis literature includes limited data on nutrition screening and multiple definitions for what constitutes malnutrition using NATs. Despite this discordance, it is clear that malnutrition is a valuable predictor of pre‐transplant mortality almost regardless of how it is defined. We require clinical and research consensus around the definition of malnutrition and the accepted processes and cut‐points for nutrition screening and assessment in cirrhosis.

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Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery

Abstract: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.

Cited by 40 publications

References 40 publications

Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

Enhanced recovery after surgery pathway in patients with soft tissue sarcoma

Systematic review with meta‐analysis: Nutritional screening and assessment tools in cirrhosis

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