Early Postoperative Nutritional Support Research Articles

CLINICAL APPLICATION OF EARLY POSTOPERATIVE NUTRITIONAL SUPPORT IN PATIENTS WITH HIGH-RISK VALVULAR HEART DISEASE.

Background : The treatment strategy of early nutritional support after cardiac surgery has gradually been adopted. However, there are no scientific guidelines for the timing and specific programs of early nutritional support. Methods: A retrospective, single-center analysis (2021-2023) was carried out including elderly patients who were admitted for valvular heart disease and received open-heart valve replacement surgery. We designated patients who started the optimized nutritional support after surgery as the optimized enteral nutritional support strategy TN (EN) group and those who received traditional nutritional support as the traditional nutritional support strategy (TN) group. The nutritional and immune indexes, postoperative complications, length of hospital stay, and hospitalization cost of the two groups were compared and analyzed. Results: We identified 378 eligible patients, comprising 193 (51%) patients in the EN group and 185 (49%) patients in the TN group. There was no significant difference in hospital mortality between the two groups, but the proportion of nosocomial pneumonia was significantly lower in the EN group than in the TN group ( P < 0.001). In the Poisson regression analysis, EN was not associated with an increase in gastrointestinal complications ( P = 0.549). The EN group also seemed to have shorter hospital stays and lower hospitalization expenses ( P < 0.001). In the comparison of postoperative gastrointestinal complications, fewer patients experienced diarrhea ( P = 0.021) and abdominal distension ( P = 0.033) in the EN group compared with the TN group. Conclusion: The optimal nutritional support strategy could effectively improve the clinical outcome of high-risk patients with valvular heart disease.

Concurrent Negative Impact of Undernutrition and Heart Failure on Functional and Cognitive Recovery in Hip Fracture Patients.

Evidence on the effects of frailty, undernutrition, and heart failure (HF) on patients with hip fractures is scarce. This retrospective cohort study aimed to examine the effects of undernutrition and HF on outcomes in patients who underwent convalescent rehabilitation after hip fracture. Undernutrition was defined as body mass index (BMI) < 20.0 (Low BMI). Heart failure (HF) was defined as a B-type natriuretic peptide (BNP) > 100 (High BNP). The study outcomes included the Functional Independence Measure motor domain (FIM-motor) and cognitive domain (FIM-cognition) at discharge. To consider the effects of low BMI, high BNP, and the simultaneous presence of both ("low BMI and high BNP"), we used multivariate linear regression analyses to examine whether these were associated with the outcomes. A total of 110 (mean age 87.4 years, 24.8% male) were analyzed. As a result, low BMI (β = -0.088, p = 0.027) and high BNP (β = -0.053, p = 0.015), each alone, were significantly associated with the FIM motor at discharge, whereas the simultaneous presence of "low BMI and high BNP" was significantly associated with the FIM motor at discharge, while the strength of the association was greater than each association alone (β = -0.152, p = 0.010). Further, the simultaneous presence of "low BMI and high BNP" was significantly associated with FIM cognition at discharge (β = -0.109, p = 0.014). Comprehensive multidisciplinary management is needed, including preoperative or early postoperative nutritional support and rehabilitation, followed by rehabilitation nutrition care management, in patients with hip fracture.

Nutritional status efficacy of early nutritional support in gastrointestinal care: A systematic review and meta-analysis

Gastrointestinal surgery is a complicated process used to treat many gastrointestinal diseases, and it is associated with a large trauma: Most patients often have different degrees of malnutrition and immune dysfunction before surgery and are prone to various infectious complications during postoperative recovery, thus affecting the efficacy of surgical treatment. Therefore, early postoperative nutritional support can provide essential nutritional supply, restore the intestinal barrier and reduce complication occurrence. However, different studies have shown different conclusions.To assess whether early postoperative nutritional support can improve the nutritional status of patients based on literature search and meta-analysis.Articles comparing the effect of early nutritional support and delayed nutritional support were retrieved from PubMed, EMBASE, Springer Link, Ovid, China National Knowledge Infrastructure, China Biology Medicine databases. Notably, only randomized controlled trial articles were retrieved from the databases (from establishment date to October 2022). The risk of bias of the included articles was determined using Cochrane Risk of Bias V2.0. The outcome indicators, such as albumin, prealbumin, and total protein, after statistical intervention were combined.Fourteen literatures with 2145 adult patients undergoing gastrointestinal surgery (1138 patients (53.1%) receiving early postoperative nutritional support and 1007 patients (46.9%) receiving traditional nutritional support or delayed nutritional support) were included in this study. Seven of the 14 studies assessed early enteral nutrition while the other seven studies assessed early oral feeding. Furthermore, six literatures had "some risk of bias," and eight literatures had "low risk". The overall quality of the included studies was good. Meta-analysis showed that patients receiving early nutritional support had slightly higher serum albumin levels, than patients receiving delayed nutritional support [MD (mean difference) = 3.51, 95%CI: -0.05 to 7.07, Z = 1.93, P = 0.05]. Also, patients receiving early nutritional support had shorter hospital stay (MD = -2.29, 95%CI: -2.89 to -1.69), Z = -7.46, P < 0.0001) shorter first defecation time (MD = -1.00, 95%CI: -1.37 to -0.64), Z = -5.42, P < 0.0001), and fewer complications (Odd ratio = 0.61, 95%CI: 0.50 to 0.76, Z = -4.52, P < 0.0001) than patients receiving delayed nutritional support.Early enteral nutritional support can slightly shorten the defecation time and overall hospital stay, reduce complication incidence, and accelerate the rehabilitation process of patients undergoing gastrointestinal surgery.

The Effects of Early Postoperative Nutrition Support on Enhanced Recovery After Lung Transplantation

<h3>Purpose</h3> There is currently no established guideline for nutritional management after lung transplantation (LT). Therefore, we have developed and introduced a protocol on early post-transplant nutrition, and verified the effectiveness of the protocol in improving nutrition-related outcomes. <h3>Methods</h3> Among 50 consecutive patients ≥18 years undergoing LT (7 from living donors) from January 2019 to April 2021 in our institution, the protocol had been applied in 22 patients since March 2020. The goal of our protocol was to start enteral nutrition or central parenteral nutrition within 48 hours after LT and we set targets of energy and protein amount as 25 kcal and 1 g per kg of ideal body weight a day by day 7. Nutritional sufficiency on day 7 and postoperative changes in body weight and muscle mass for 3 months after LT were retrospectively compared between the pre- and the post-protocol groups. Muscle mass was assessed by cross-sectional areas of the erector spinae muscles, which was evaluated using computed tomography. <h3>Results</h3> Regarding perioperative factors, there were no significant differences between two groups, while intraoperative extracorporeal circulation was more frequently used in the post-group compared to the pre-group (95% vs 64%, <i>p</i>=0.014). The number of cases in which tube feeding and central parenteral nutrition were started within 3 days after LT was significantly larger in the post-group than that in the pre-group (45% vs 7%, <i>p</i>=0.002; and 82% vs 29%, <i>p</i><0.001, respectively). Only 5 patients of the pre-group, who were extubated on day 2, started oral intake within 3 days after LT. The sufficiency rates of energy and protein on day 7 were significantly better in the post-group, compared to the pre-group (84% vs 69%, <i>p</i>=0.011; and 87% vs 74%, <i>p</i>=0.017, respectively). Body weight loss at 3 months after LT was more suppressed in the post-group than that in the pre-group (-0.5 kg vs -4.4 kg, <i>p</i>=0.034). The muscle mass decreased 2 weeks after LT in both groups (-14% in the post-group vs -16% in the pre-group, <i>p</i> = 0.105), while the muscle loss at 3 months after LT was significantly suppressed in the post-group than that in the pre-group (-5% vs -12%, <i>p</i>=0.034). <h3>Conclusion</h3> Although the target sufficiency rates had been incompletely achieved yet after the protocol was introduced, early nutrition support after LT was positively associated with the suppression of weight loss and muscle loss.

The choice and curative effect analysis of early postoperative nutritional support for severe traumatic brain injury patients

Objective To explore the differences of curative effect and short-term prognosis to severe traumatic brain injury patients with three different early postoperative nutritional supports. Methods A retrospective study was performed on 60 severe traumatic brain injury patients received in Neurosurgical Intensive Care Unit of Northern Jiangsu People's Hospital from July 2014 to July 2016. A total of 60 cases were randomly divided into the early enteral nutrition support therapy group, the early parenteral nutrition group, and the early compound nutrition group.The clinical indicators such as basic clinical characteristics before treatment, the nutrition data in two weeks, the length of stay in the Neurosurgical Intensive Care Unit, complications and GCS scores between the three groups were observed and analyzed. Results The indicators of early compound nutrition group were fasting blood-glucose (5.74±0.64) mmol/L, pre-albumin(203.80±10.45) mg/L, total serum protein(61.99±1.34) g/L, blood hemoglobin (114.53±2.69) g/L, C-reactive protein(0.37±0.06) mg/dl. The length of stay in Neurosurgical Intensive Care Unit was (11.6±0.42) days in the compound nutrition group while those in the early enteral nutrition group was (13.20±0.42) days and those in the early parenteral nutrition group was(14.65±0.42) days. The postoperative complications of the compound nutrition group were significantly lower than other two groups. The GCS scores of early compound nutrition group was(11.40±1.60), which was the best in three groups. The differences were statistically significant (P<0.05). Conclusions Early compound nutrition support has an exact curative effect on postoperative severe traumatic brain injury patients in Neurosurgical Intensive Care Unit. It can obviously improve the nutrition status of patients with less complications, shorter length of stay in Neurosurgical Intensive Care Unit, higher safety and lower degree of coma, worth clinical promotion. Key words: Nutritional support; Severe traumatic brain injury; Early enteral nutrition; Parenteral nutrition; Comparative effectiveness research

Can't we just let them eat? Defining and addressing under-use of the oral route in a post-surgical ward.

Early postoperative nutrition improves outcomes. However, postoperative fasting is a tradition that persists in some areas of surgical practice. This retrospective audit was performed to benchmark current nutrition support practices on a mixed specialty surgical ward in a large tertiary-referral teaching hospital. Thirty-eight consecutive patients, who were undergoing gynaecological or urological surgical procedures between November 2010 and May 2011, had data collected including demographics, nutritional status, details of surgery performed, postoperative complications, modes of nutrition support and time taken to progress to solid oral diet. Energy and protein provision and adequacy was estimated for the first week postoperatively. Sixteen patients commenced parenteral nutrition postoperatively without any trial of oral or enteral nutrition. Reasons for using parenteral nutrition included observed or expected gut dysmotility and lack of enteral access for feeding. These patients did demonstrate longer length of stay and higher rates of postoperative complications. Given the proportion of patients initiated immediately on parenteral nutrition and maintained on it alone, it can be argued that these patients are not able to demonstrate tolerance and receive the benefits of early enteral feeding predicted by studies within these patient groups. None of the patients met their energy and protein requirements in the first week postoperatively. Despite support in the literature, it can be challenging to implement early postoperative nutrition support after pelvic surgery. It may be necessary to employ a variety of strategies to change this aspect of practice and promote earlier introduction of an oral diet or the use of enteral nutrition.

An Investigation into the Current Peri-Operative Nutritional Management of Oesophageal Carcinoma Patients in Major Carcinoma Centres in England

Patients with oesophageal carcinoma are at high risk of malnutrition. The aim of this study was to assess current practice for the nutritional management of patients following surgery for oesophageal carcinoma. A postal questionnaire was sent to 82 dietetic departments of those hospitals in England identified as major centres for upper gastrointestinal surgery. Of the 66 (80%) responses received, 22 (33%) centres routinely perform pre-operative nutritional screening/assessment on oesophageal carcinoma patients. Centres with dietetic support dedicated to these patients are more likely to perform a pre-operative nutritional assessment (n = 17; 55%) than those without (n = 5; 14%; P < 0.001; chi(2) = 12.17). Pre-operative nutritional support is routinely provided in only 11 (17%) centres with the majority of centres (n = 50; 75%), providing it if patients are considered malnourished only. A total of 47 (70%) centres routinely provide postoperative nutritional support with jejunal feeding being the most commonly chosen route. Dedicated dietetic support is provided at 31 (47%) centres. Those centres with a dedicated dietitian are more likely to provide early postoperative nutritional support (n = 27; 87%) than those without (n = 20; 57%; P = 0.007; chi(2) = 7.195) and more likely to review patients routinely following discharge from hospital (n = 25 [81%] with a dietitian versus n = 17 [49%] without; P = 0.007; chi(2) = 7.2). The nutritional management of patients following surgery for upper gastrointestinal carcinoma is not uniform with practice varying considerably between centres. Those centres with a dedicated dietitian are more likely to assess patients' nutritional status and provide nutritional support.

The role of nutritional support in transplant recipients: two case reports

NUTRITIONAL SUPPORT is an integral part of the management of critically ill patients. Few studies have shown the importance of nutritional intervention among transplant recipients. Candidates for transplantation (Tx) with chronic end-stage liver disease are often malnourished and operative stress may further decrease their metabolic stores. Early postoperative nutritional support improves would healing and decreases rates of viral infection, sepsis, and bacterial translocation. Use of an enteral formula enriched with glutamine, an oxidative fuel for rapidly replicating cells, may help to minimize atrophy of intestinal mucosa associated with total parenteral nutrition (TPN). Advances in operative techniques and shortened stays of patients in the intensive care unit (ICU) have been associated with earlier resumption of oral diet after Tx. Nevertheless, dietary supplementation is needed for patients with severe morbid risk factors before Tx, including renal failure, and severe malnutrition, and in recipients who develop complications after Tx. Herein, we present 2 patients who suffered severe post-Tx complications, and successfully recovered with the aid of nutritional support.

Effect of Early Postoperative Nutritional Support on Skin Wound and Colon Anastomosis Healing

Improved healing occurs in nutritionally depleted rats given early postoperative compared with delayed feeding. The present study was designed to test the hypothesis that delay in postoperative feeding of rats normally nourished at the time of operation would also be detrimental to wound healing. Fully nourished rats weighing 288 to 342 g were divided into three groups (10 rats per group). All rats had central vein catheters inserted, celiotomy with division and reanastomsis of the colon and dorsal skin incisions, under ip pentobarbital anesthesia. With no oral intake allowed postoperatively, group 1 rats were maintained in iv 5% Dextrose electrolytes and vitamins (5% DSV); group 2 was given the 5% D/SV until the third postoperative day when they were placed on TPN (4.5% amino acids 15% Dextrose, 10% Intralipids); and group 3 was given TPN from the first postoperative day. Rats were sacrificed 6 days postoperatively and final weight, skin wound breaking strength (WBS) and colon anastomosis bursting pressure (CBP) were measured. Findings were % weight change -27.8 +/- 1.5 for Group 1, -12.6 +/- 1.0 for Group 2, and -6.9 +/- 8 for group 3 (p less than 0.0001). Wound measurements for STS on fresh specimens were 88.6 +/- 10.0 g for group 1, 89.1 +/- 8.4 g for group 2, and 87.1 +/- 11.1 g for group 3. WBS for formalin-fixed specimens were 313.5 +/- 29.7 g for group 1, 323.4 +/- 38.4 g for group 2, and 382 +/- 25.2 g for group 3 (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Effective early postoperative nutrition by defined formula diet via needle-catheter jejunostomy

To assess the safety and cost effectiveness of needle-catheter jejunostomy for the purpose of feeding defined formula diet in the early postoperative period, 38 patients undergoing radical pelvic operations for malignant tumors of the female reproductive tract were studied. For purposes of this study, protein-calorie malnutrition was diagnosed when the serum albumin level was below 3.2 g/100 ml, weight loss exceeded 9.9 kg, or there was an interruption in normal dietary intake for greater than 10 days. Data collected included major indication for placement of the jejunal feeding catheter, daily volume of defined formula diet administered, duration of use of the feeding catheter, and the interval between placement and removal of the needle-catheter jejunostomy. Catheter-related complications were recorded throughout the study, as was information on those who required total parenteral nutrition in addition to needle-catheter jejunostomy. Careful note was made of the magnitude of total parenteral nutrition required and the reason for failure of enteral feeding. The use of defined formula diet via needle-catheter jejunostomy is a safe, costeffective technique for early postoperative nutritional support.

Early Postoperative Nutritional Support Using the Serosal Tunnel Jejunostomy

A silicone rubber serosal tunnel jejunostomy for postoperative nutritional therapy was placed in 38 patients who had major operations. A dilute, chemically defined diet was begun within 48 hours of surgery and an attempt made to advance it slowly to full strength by the fifth day. No catheter-related complications occurred. Intravenous fluid therapy was shortened to less than three days in 11 (29%) patients. Only 17 (45%) patients tolerated full-strength feedings within the protocol time. Three (8%) patients depended on their tube feedings for over 30 days and the need for parenteral nutrition was avoided. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the pded. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the patients with albumin greater than 4 g/dl had no problems. Postoperative feeding utilizing the serosal tunnel jejunostomy is technically safe, but feeding difficulties can be anticipated in those patients who are septic or severely malnourished; these are the patients whose nutritional needs are the greatest. The greatest benefits accrue to those patients who are in need of long-term nutritional support. We recommend routine placement of these catheters in major operations.