Emanuele Rinninella1, Alberto Biondi2, Marco Cintoni3, Pauline Raoul4,5, Francesca Scialanga1, Eleonora Persichetti5, Gabriele Pulcini5, Roberto Pezzuto2, Roberto Persiani2,4, Domenico D'Ugo2,4, Antonio Gasbarrini4,6, Maria Cristina Mele4,5. 1. UOC di Nutrizione Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy. 2. UOC di Chirurgia Generale, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy. 3. Scuola di Specializzazione in Scienza dell'Alimentazione, Università di Roma Tor Vergata, Via Montpellier 1, 00133 Rome, Italy. 4. Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica Del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy. 5. UOSD di Nutrizione Avanzata in Oncologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy. 6. UOC di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy.
Abstract
BACKGROUND: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. METHODS: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into "NutriCatt + ERAS" (n = 166) or "standard ERAS" patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01-0.56; p = 0.009). CONCLUSIONS: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery.
BACKGROUND: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. METHODS: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into "NutriCatt + ERAS" (n = 166) or "standard ERAS" patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERASpatients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERASpatients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERASpatients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERASpatients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01-0.56; p = 0.009). CONCLUSIONS: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAScolorectal surgery.
Authors: B Rumstadt; N Guenther; P Wendling; R Engemann; C T Germer; M Schmid; K Kipfmueller; M K Walz; W Schwenk Journal: World J Surg Date: 2009-08 Impact factor: 3.352
Authors: Magdalena Pisarska; Michał Pędziwiatr; Piotr Małczak; Piotr Major; Sebastian Ochenduszko; Anna Zub-Pokrowiecka; Jan Kulawik; Andrzej Budzyński Journal: Int J Surg Date: 2016-11-19 Impact factor: 6.071
Authors: Digant Gupta; Carolyn A Lammersfeld; Jessica L Burrows; Sadie L Dahlk; Pankaj G Vashi; James F Grutsch; Sara Hoffman; Christopher G Lis Journal: Am J Clin Nutr Date: 2004-12 Impact factor: 7.045
Authors: Arved Weimann; Marco Braga; Franco Carli; Takashi Higashiguchi; Martin Hübner; Stanislaw Klek; Alessandro Laviano; Olle Ljungqvist; Dileep N Lobo; Robert Martindale; Dan L Waitzberg; Stephan C Bischoff; Pierre Singer Journal: Clin Nutr Date: 2017-03-07 Impact factor: 7.324
Authors: David E Flynn; Derek Mao; Stephanie Yerkovich; Robert Franz; Harish Iswariah; Andrew Hughes; Ian Shaw; Diana Tam; Manju Chandrasegaram Journal: World J Gastrointest Oncol Date: 2021-03-15