Preoperative Nutrition Intervention in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study.

Irene Deftereos,Janan Arslan,Justin M.-C Yeung,Nicole Kiss,Elizabeth Isenring,Vanessa M Carter

doi:10.3390/nu13093205

Irene Deftereos, Janan Arslan + Show 4 more

Open Access

https://doi.org/10.3390/nu13093205

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Abstract

Background: Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated. Methods: The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded. Results: Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries (p < 0.001 and p = 0.029, respectively). Neoadjuvant therapy (p = 0.003) and malnutrition (p = 0.046) remained independently associated with receiving dietetics intervention; however, 31.3% of malnourished patients had not seen a dietitian. Patients who received ≥3 dietetics appointments had lower mean (SD) percentage weight loss at the 1-month preoperative timeframe compared with patients who received 0–2 appointments (1.2 (2.0) vs. 3.1 (3.3), p = 0.001). Patients who received ONS for >2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), p = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, p = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient −7.3, 95% CI −14.3, −0.3, p = 0.04). Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support.

Highlights

Curative intent surgeries for upper gastrointestinal (UGI) cancer including oesophagectomy, gastrectomy, and pancreatectomy carry a high postoperative morbidity risk [1]
The ESPEN guidelines recommend that patients undergoing UGI cancer surgery should receive preoperative oral nutrition supplements regardless of their nutritional status; only 30% of patients in this study reported taking high energy high protein (HEHP) supplements prior to surgery
Results of this study indicate that more intensive dietetics care and the extended use of oral nutrition supplements can reduce immediate preoperative weight loss

Summary

Introduction

Curative intent surgeries for upper gastrointestinal (UGI) cancer including oesophagectomy, gastrectomy, and pancreatectomy carry a high postoperative morbidity risk [1]. Patients with UGI cancer can experience high rates of preoperative malnutrition, which has been associated with poor surgical outcomes, including increased length of stay (LOS) and complications [2]. Benchmarking current practice can assist in targeting key areas for immediate improvement and education, as well as further research to inform the development of UGI specific evidence-based guidelines. No large multi-centre studies have been conducted to investigate and benchmark current perioperative nutrition practice and associated outcomes in patients undergoing curative intent UGI cancer resection. Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; there is limited understanding of interventions received in current clinical practice. Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support

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