11 Tube Feeding Through Surgery, Impact on Glucose Control in Burn Patients

Abstract

Abstract Introduction The hypermetabolic state experienced by burn patients post injury puts nutritional support at the forefront of these patients’ care. Enhanced Recovery After Surgery (ERAS) algorithms include a radical approach of feeding patients up to surgery with reported advantages like earlier recovery of GI function, among others. The purpose of this study was to assess perioperative blood glucose (BG) levels in patients fed up to and through surgery at our institution. Methods Charts of selected surgical burn patients were reviewed and categorized on the basis of diabetic status and whether they had procedures in which feeds were continued to within four hours of surgery (“fed”) and stopped at least four hours prior to surgery (“unfed”). Percent change in pre- and post-op BG levels were compared between groups. Wilcoxon Rank-Sum and Two-Sample testing were used for statistical analyses. Results See Table 1. Data collection yielded 32 patients with 106 unfed and 92 fed procedures. There was a significantly larger percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the unfed vs. fed groups across all procedures, prior to grouping based on diabetic status (p = 0.014 and p = 0.009, respectively). There was a statistically significant difference in the percent change in BG levels from 24-hr pre-op to 12- and 24-hr post-op in the pre-diabetes group (p = 0.021 and p = 0.026, respectively). Conclusions Our data shows better BG control in fed procedures with lower percent change from pre-op to post-op overall, and in the pre-diabetes group. These findings are in line with ERAS literature. Controlling BG ranges post-op is critical to prevent complications and promote healing. Improved BG control using perioperative nutrition could guide practices related to perioperative workup of burn patients. This is worth further investigation since better BG management has been associated with superior patient outcomes. Applicability of Research to Practice 1) Using enteral nutrition up to and/or through surgery contributes to better glycemic control postoperatively in surgical burn patients. 2) The most pronounced benefits of perioperative enteral nutrition in terms of glycemic control are seen in burn patients with pre-diabetes.