Abstract
To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no permitiendo la extensión innecesaria del ayuno.
Highlights
Eating difficulties exists among surgical cancer patients, due to physiological factors associated with the disease process or the required fasting time for a range of laboratory and surgical procedures, which can culminate in malnutrition associated with the hospitalization.Patients with gastrointestinal tumors are predisposed to malnutrition related to the hospitalization itself, aspects associated with the diagnosis and the treatment, which compromise their organism’s ability to react to the fasting periods, and affect their postoperative recovery and prognosis[1]
The literature shows the improvement in postoperative recovery and patients’ wellbeing related to the reduction of the fasting period by offering a preoperative solution rich in carbohydrates, two to three hours before the induction of anesthesia, shortened fasting length and an early oral nutrition during the postoperative period
The mean difference among patients who had the measure of weight on admission and discharge was 1.5 Kg.The average length of stay was 15.4 days (SD=13.4), the total length of fasting was 107.6 hours (SD=73) or 4.5 days (Table 1)
Summary
Eating difficulties exists among surgical cancer patients, due to physiological factors associated with the disease process or the required fasting time for a range of laboratory and surgical procedures, which can culminate in malnutrition associated with the hospitalization.Patients with gastrointestinal tumors are predisposed to malnutrition related to the hospitalization itself, aspects associated with the diagnosis (type of tumor, staging, among others) and the treatment (radiotherapy and chemotherapy), which compromise their organism’s ability to react to the fasting periods, and affect their postoperative recovery and prognosis[1]. The literature shows the improvement in postoperative recovery and patients’ wellbeing related to the reduction of the fasting period by offering a preoperative solution rich in carbohydrates, two to three hours before the induction of anesthesia, shortened fasting length and an early oral nutrition during the postoperative period. All these initiative are linked to The Enhanced Recovery After Surgery (ERAS), a project created to optimize the recovery and perioperative management of surgical patients, and proposing care elements in all perioperative period[3,4,5,6,7]. Reducing preoperative fasting time mitigates the postoperative insulin resistance[3] and does not seem to be associated with complications, such as bronchoaspiration[4] during the anesthetic induction, besides it, reduces the hospital staying without compromising the quality of patient care[5,6,7]
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