Abstract
BackgroundSmall randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking.MethodsUsing a nationwide administrative-financial database (Premier Healthcare Database), we examined the association between early ONS use and postoperative clinical outcomes in patients undergoing elective open or laparoscopic CRS between 2008 and 2014. Early ONS was defined as the presence of charges for ONS before postoperative day (POD) 3. The primary outcome was composite infectious complications. Key secondary efficacy (intensive care unit (ICU) admission and gastrointestinal complications) and falsification (blood transfusion and myocardial infarction) outcomes were also examined. Propensity score matching was used to assemble patient groups that were comparable at baseline, and differences in outcomes were examined.ResultsOverall, patients receiving early ONS were older with greater comorbidities and more likely to be Medicare beneficiaries with malnutrition. In a well-matched sample of early ONS recipients (n = 267) versus non-recipients (n = 534), infectious complications were significantly lower in early ONS recipients (6.7% vs. 11.8%, P < 0.03). Early ONS use was also associated with significantly reduced rates of pneumonia (P < 0.04), ICU admissions (P < 0.04), and gastrointestinal complications (P < 0.05). There were no significant differences in falsification outcomes.ConclusionsAlthough early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, the use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity score-matched study using real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients.
Highlights
Perioperative malnutrition is a widely prevalent and potentially modifiable risk factor in patients undergoing colorectal surgery (CRS)
Malnutrition has been associated with increased hospital length of stay (LOS) (Garth et al 2010), readmissions, costs of care (Bliss et al 2015), and especially increased risk of postoperative infection (Bohl et al 2016; Fukuda et al 2015)
Postoperative infection remains among the major complications following CRS (Smith et al 2004), and quality improvement initiatives aimed at reducing surgical infections focus on appropriate administration of prophylactic antibiotics, perioperative hair clipping, normothermia (Arriaga et al 2009; Berenguer et al 2010), and early perioperative nutritional support (Wischmeyer et al 2018)
Summary
Perioperative malnutrition is a widely prevalent and potentially modifiable risk factor in patients undergoing colorectal surgery (CRS). Postoperative nutritional support is vital in maintaining nutritional status during the catabolic postoperative period and underscored by evidence for early oral intake following surgery as a routine part of ERAS protocols (Vlug et al 2012; Weimann et al 2006; Wischmeyer 2016). Nutritional therapy, often via oral nutritional supplements (ONS), may be required during the postoperative period following major surgery to avoid significant risk for the occurrence of postoperative malnutrition (Wischmeyer et al 2018; Weimann et al 2017). Recent guidelines suggest that ONS should be routinely included in the postoperative care of gastrointestinal (GI) surgery patients to meet their nutritional needs (Wischmeyer et al 2018). Real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking
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