Evaluating the impact of a nutrition-focused eras protocol in hepatobiliary and pancreatic surgery patients: a preliminary analysis

Abstract

Presenter: Taylor Abraham MD | Bon Secours Mercy Health St. Elizabeth Youngstown Hospital Background: Nutritional status is an important independent predictor of clinical outcomes after surgery. Optimized surgical nutrition has been found to improve the clinical and health outcomes of surgical patients. A perioperative nutrition protocol was implemented to provide oral nutritional supplements to all eligible surgery patients in the perioperative period to optimize their nutritional status and improve their clinical outcomes. Methods: Between January 1, 2019 and November 1, 2020, patients scheduled to undergo major hepatobiliary or pancreatic surgery by a single surgeon at a single institution was seen by the registered oncology dietitian 1 week prior to surgery. During this visit, the patients were provided with 1 bottle of clear carbohydrate drink (Ensure Pre-Surgery), and 10 bottles of immunonutrition (Ensure Immunonutrition Surgery Shake). Patients also received an educational flyer outlining the benefits of nutritional supplements pre- and post-surgery as well as specific instructions and checklists to promote compliance. During the patient's hospital stay, the nutritional supplements were started per the surgical nutrition protocol and a 5-day supply of immunonutrition shakes (Ensure) or therapeutic nutrition powder for wound healing (Juven) were provided to take home and consume post-operatively. Outcomes of interest included length of hospital stay, 30-day readmissions and post-operative infectious complications. Outcomes of these patients were compared to those of historical controls - patients undergoing similar procedures between January and December of 2018, prior to the initiation of the nutrition protocol. Results: A total of 92 patients undergoing major hepatobiliary and pancreatic surgeries were included in the analysis of which 67 patients were given the perioperative nutrition protocol and 25 were historical controls. Overall, patients were mainly female (57%), on public insurance (57%) and had a mean age of 65. Comparative analysis showed improvements in favor of the perioperative nutrition protocol cohort in terms of reduced length of stay (8.54 vs. 7.89 days), 30-day readmissions (24% vs. 19%) and infectious complications (20% vs. 16.4%). Conclusion: The results of our analysis confirm the importance of perioperative nutrition protocols in optimizing the clinical outcomes of patients undergoing major hepatobiliary and pancreatic surgeries. The improvements observed can result in decreased financial burden for the patients and the institution. Future research is needed to validate the findings of our preliminary analysis.