Prevalence and Consequences of Preoperative Weight Loss in Gynecologic Surgery.

Basile Pache,Patrice Mathevet,Amaniel Kefleyesus,Chahin Achtari,Fabian Grass,Martin Hübner

doi:10.3390/nu11051094

Basile Pache, Patrice Mathevet + Show 4 more

Open Access

https://doi.org/10.3390/nu11051094

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Journal: Nutrients	Publication Date: May 17, 2019
Citations: 9	License type: CC BY 4.0

Affiliation: Hôpital de l'enfance, University of Lausanne

Abstract

Preoperative malnutrition and weight loss negatively impact postoperative outcomes in various surgical fields. However, for gynecologic surgery, evidence is still scarce, especially if surgery is performed within enhanced recovery after surgery (ERAS) pathways. This study aimed to assess the prevalence and impact of preoperative weight loss in patients undergoing major gynecologic procedures within a standardized ERAS pathway between October 2013 and January 2017. Out of 339 consecutive patients, 33 (10%) presented significant unintentional preoperative weight loss of more than 5% during the 6 months preceding surgery. These patients were less compliant to the ERAS protocol (>70% of all items: 70% vs. 94%, p < 0.001) presented more postoperative overall complications (15/33 (45%) vs. 69/306 (22.5%), p = 0.009), and had an increased length of hospital stay (5 ± 4 days vs. 3 ± 2 days, p = 0.011). While patients experiencing weight loss underwent more extensive surgical procedures, after multivariate analysis, weight loss ≥5% was retained as an independent risk factor for postoperative complications (OR 2.44; 95% CI 1.00–5.95), and after considering several surrogates for extensive surgery including significant blood loss (OR 2.23; 95% CI 1.15–4.31) as confounders. The results of this study suggest that systematic nutritional screening in ERAS pathways should be implemented.

Highlights

Preoperative conditioning, recognized as an efficient way to improve surgical outcomes, has been of growing interest in the last decades and endorsed by nutritional societies and perioperative care guidelines [1,2]
While specific enhanced recovery after surgery (ERAS) guidelines incorporate multimodal interventions aiming to improve patients’ physical and mental well-being [7], the nutritional aspect focuses on the immediate perioperative period, suggesting limited preoperative fasting, carbohydrate repletion, and early postoperative re-alimentation
Significant differences between the two groups (≥5% vs.

Summary

Introduction

Preoperative conditioning, recognized as an efficient way to improve surgical outcomes, has been of growing interest in the last decades and endorsed by nutritional societies and perioperative care guidelines [1,2]. Nutritional support strategies have been evaluated and validated for different surgical specialties, including colorectal [3], hepatic [4], or gastric [5] surgery, and for more specific settings, such as surgery for Crohn’s disease [6]. While specific enhanced recovery after surgery (ERAS) guidelines incorporate multimodal interventions aiming to improve patients’ physical and mental well-being [7], the nutritional aspect focuses on the immediate perioperative period, suggesting limited preoperative fasting, carbohydrate repletion, and early postoperative re-alimentation. Despite implementation of ERAS guidelines in the gynecological department in 2012, nutritional screening and therapy are not an integral part of daily clinical practice at the present

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