V Lohsiriwat1. 1. Colorectal Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lung Road, Bangkok Noi, Bangkok, 10700, Thailand, bolloon@hotmail.com.
Abstract
BACKGROUND: The aim of the present study was to evaluate the effects of preoperative nutritional status on the short-term outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery. METHODS: This prospective observational study included 149 patients who underwent elective resection of colorectal cancer with ERAS from January 2011 to January 2014 in a university hospital. Subjective global assessment (SGA) was used to determine preoperative nutritional status. Primary outcomes included the length of postoperative stay, postoperative morbidity, gastrointestinal recovery, and 30-day readmission. RESULTS: The patients were divided into 3 groups according to the SGA classification. There were 96 patients (64.4 %) in SGA-A (well-nourished), 48 (32.2 %) in SGA-B (mild to moderately malnourished), and 5 (3.4 %) in SGA-C (severely malnourished). Patients in SGA-A had the median length of postoperative stay of 4 days (range 2-23), which was significantly shorter compared to SGA-B (5 days; range 2-16; p < 0.01) and SGA-C (7 days; range 4-17; p < 0.01). The overall complication rates of SGA-A, SGA-B, and SGA-C patients were 11, 31 % (adjusted OR 3.76; 95 % CI 1.36-10.36; p < 0.01) and 40 % (adjusted OR 2.15; 95 % CI 0.07-63.64; p = 0.66). Mean time to resumption of normal diet and time to first defecation were 1.6 ± 1.3 and 2.2 ± 0.9 days in SGA-A, 2.6 ± 1.7 and 3.1 ± 1.6 days in SGA-B (p < 0.01 compared to SGA-A) and 3.2 ± 2.4 days and 2.6 ± 1.5 days in SGA-C (p = 0.07 and p = 0.1 compared to SGA-A, respectively). No 30-day mortality occurred in any group. One patient in SGA-A (1 %), and 3 patients in SGA-B (6 %) had unplanned 30-day re-admission; p = 0.11. CONCLUSIONS: Within an ERAS programme for colorectal cancer surgery, malnourished patients were at risk for increased postoperative morbidity, delayed recovery of gastrointestinal function, and prolonged length of hospital stay.
BACKGROUND: The aim of the present study was to evaluate the effects of preoperative nutritional status on the short-term outcomes of an enhanced recovery after surgery (ERAS) programme for colorectal cancer surgery. METHODS: This prospective observational study included 149 patients who underwent elective resection of colorectal cancer with ERAS from January 2011 to January 2014 in a university hospital. Subjective global assessment (SGA) was used to determine preoperative nutritional status. Primary outcomes included the length of postoperative stay, postoperative morbidity, gastrointestinal recovery, and 30-day readmission. RESULTS: The patients were divided into 3 groups according to the SGA classification. There were 96 patients (64.4 %) in SGA-A (well-nourished), 48 (32.2 %) in SGA-B (mild to moderately malnourished), and 5 (3.4 %) in SGA-C (severely malnourished). Patients in SGA-A had the median length of postoperative stay of 4 days (range 2-23), which was significantly shorter compared to SGA-B (5 days; range 2-16; p < 0.01) and SGA-C (7 days; range 4-17; p < 0.01). The overall complication rates of SGA-A, SGA-B, and SGA-C patients were 11, 31 % (adjusted OR 3.76; 95 % CI 1.36-10.36; p < 0.01) and 40 % (adjusted OR 2.15; 95 % CI 0.07-63.64; p = 0.66). Mean time to resumption of normal diet and time to first defecation were 1.6 ± 1.3 and 2.2 ± 0.9 days in SGA-A, 2.6 ± 1.7 and 3.1 ± 1.6 days in SGA-B (p < 0.01 compared to SGA-A) and 3.2 ± 2.4 days and 2.6 ± 1.5 days in SGA-C (p = 0.07 and p = 0.1 compared to SGA-A, respectively). No 30-day mortality occurred in any group. One patient in SGA-A (1 %), and 3 patients in SGA-B (6 %) had unplanned 30-day re-admission; p = 0.11. CONCLUSIONS: Within an ERAS programme for colorectal cancer surgery, malnourished patients were at risk for increased postoperative morbidity, delayed recovery of gastrointestinal function, and prolonged length of hospital stay.
Authors: Andrew Ukleja; Kevin L Freeman; Karen Gilbert; Marty Kochevar; Michael D Kraft; Mary K Russell; Melanie H Shuster Journal: Nutr Clin Pract Date: 2010-08 Impact factor: 3.080
Authors: K C H Fearon; O Ljungqvist; M Von Meyenfeldt; A Revhaug; C H C Dejong; K Lassen; J Nygren; J Hausel; M Soop; J Andersen; H Kehlet Journal: Clin Nutr Date: 2005-04-21 Impact factor: 7.324
Authors: U O Gustafsson; M J Scott; W Schwenk; N Demartines; D Roulin; N Francis; C E McNaught; J MacFie; A S Liberman; M Soop; A Hill; R H Kennedy; D N Lobo; K Fearon; O Ljungqvist Journal: Clin Nutr Date: 2012-09-28 Impact factor: 7.324
Authors: A S Detsky; J P Baker; R A Mendelson; S L Wolman; D E Wesson; K N Jeejeebhoy Journal: JPEN J Parenter Enteral Nutr Date: 1984 Mar-Apr Impact factor: 4.016
Authors: L Cid Conde; T Fernández López; P Neira Blanco; J Arias Delgado; J J Varela Correa; F F Gómez Lorenzo Journal: Nutr Hosp Date: 2008 Jan-Feb Impact factor: 1.057
Authors: David E Messenger; Nathan J Curtis; Adam Jones; Emma L Jones; Neil J Smart; Nader K Francis Journal: Surg Endosc Date: 2016-09-08 Impact factor: 4.584
Authors: Riccardo Caccialanza; Alessandro Laviano; Cristina Bosetti; Mariateresa Nardi; Valentina Casalone; Lucilla Titta; Roberto Mele; Giovanni De Pergola; Francesco De Lorenzo; Paolo Pedrazzoli Journal: Support Care Cancer Date: 2022-07-06 Impact factor: 3.603
Authors: Francisco José Sánchez-Torralvo; Iván González-Poveda; María García-Olivares; Nuria Porras; Montserrat Gonzalo-Marín; María José Tapia; Santiago Mera-Velasco; José Antonio Toval-Mata; Manuel Ruiz-López; Joaquín Carrasco-Campos; Julio Santoyo-Santoyo; Gabriel Olveira Journal: Nutrients Date: 2022-04-02 Impact factor: 5.717