Abstract
Patients undergoing major gastrointestinal (GI) surgery, particularly those with malignancies, have a high risk for malnutrition, requiring perioperative nutritional support to reduce complications. During the Nutrition Insights Day (NID), nutritional data of this patient population were documented in seven Asian countries. Observational, cross-sectional study with retrospective data collection of nutritional status, calorie/protein targets/intake, and type of clinical nutrition for up to 5 days before NID. Adult patients following major GI surgery, pre-existing/at (high) risk for malnutrition, on enteral (EN) and/or parenteral nutrition (PN) and latest surgery within 10 days before the NID. Burns, mechanical ventilation on NID, oral nutrition and/or oral nutritional supplements (ONS) on the day before the NID, and emergency procedures. 536 patients from 83 hospitals, mean age 58.8±15.1 years, 59.1% males, were eligible. Leading diagnosis were GI diseases (48.7%) and GI cancer (45.9%). Malnutrition risk was moderate to high in 54% of patients, low in 46%. Hospital length of stay (LOS) before the NID was 9.3±19.0 days, and time since last surgery 3.7±2.4 days. Lowest caloric/protein deficits were observed in patients receiving EN+PN, followed by PN alone and EN alone. Type of clinical nutrition, Body Mass Index and LOS on surgical intensive care unit (SICU) and/or surgical ward were independent predictors of caloric and of protein deficit. There is a high prevalence of postoperative nutritional deficits in Asian GI surgery patients, who are either preoperatively malnourished or at risk of malnutrition, indicating a need to improve nutritional support and education.
Highlights
536 eligible patients from 83 hospitals in 7 participating countries were included in this observational study as follows: South Korea (n 1⁄4 143, 9 sites), India (n 1⁄4 122, 23 sites), Taiwan (n 1⁄4 81, 9 sites), Vietnam (n 1⁄4 74, 7 sites), Philippines (n 1⁄4 59, 16 sites), Indonesia (n 1⁄4 38, 9 sites), and Thailand (n 1⁄4 19, 10 sites)
The multivariate regression analysis revealed type of clinical nutrition (PN þ EN p 1⁄4 0.001, OR 0.212; 95% CI 0.084e0.536), Body Mass Index (BMI) (p 1⁄4 0.005, OR 1.072; 95% CI: 1.022; 1.125), and length of stay (LOS) in surgical intensive care unit (SICU) and/or surgical ward (p 1⁄4 0.005, OR 0.942; 95% CI: 0.903; 0.982) as independent predictors for the occurrence of caloric deficit (Table 2)
The multivariate analysis revealed the absence of nutrition support team in the hospital (p 1⁄4 0.008; OR 0.169, 95% CI: 0.060; 0.479) and type of clinical nutrition as independent predictors for protein deficit (Table 2)
Summary
Adequate perioperative nutritional support in patients malnourished, or at high risk of malnutrition-related complications, is associated with improved clinical outcomes [2]. Patients undergoing major gastrointestinal (GI) surgery, those with malignancies, have a high risk for malnutrition, requiring perioperative nutritional support to reduce complications. Inclusion criteria: Adult patients following major GI surgery, pre-existing/at (high) risk for malnutrition, on enteral (EN) and/or parenteral nutrition (PN) and latest surgery within 10 days before the NID. Body Mass Index and LOS on surgical intensive care unit (SICU) and/or surgical ward were independent predictors of caloric and of protein deficit. Conclusion: There is a high prevalence of postoperative nutritional deficits in Asian GI surgery patients, who are either preoperatively malnourished or at risk of malnutrition, indicating a need to improve nutritional support and education.
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