Postoperative Dietary Intake Research Articles

Changes in the Gut Microbiota Composition and Their Relation to Dietary Intake After Bariatric Surgery.

Prior studies have demonstrated that both dietary components and bariatric surgery modify the gut microbiota's composition. However, there is a scarcity of research that has examined the relationship between post-surgical dietary intake and changes in the gut microbiota. The aim of this study was to assess changes in gut microbiota following bariatric surgery and examine their association with postoperative dietary intake. The present study involved a sample of 42 adult women who were potential candidates for bariatric surgery, i.e., laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (LSG). The assessment of dietary intake was conducted through the use of three-day food records, both at baseline and six months following the surgical procedure. The gut microbiota was determined through the detection of 16S ribosomal RNA (16S rRNA) gene sequencing. After six months, a significant increase in abundance of Firmicutes (P = 0.01), Bifidobacterium (P = 0.01), and Ruminococcus (P = 0.04) in the LSG group was found. In contrast to the observed rise in Enterobacteria (P = 0.02) levels in the LRYGB group, no significant changes were detected in the composition of other gut microbiota over the 6-month monitoring period subsequent to LRYGB. The results of our study indicate that there is not a statistically significant relationship between dietary consumption and changes in the composition of the gut microbiota in individuals who have undergone LRYGB and LSG. Our findings suggest that there may not be a significant correlation between dietary intake following LRYGB and LSG, and the observed alterations in the gut microbiota during a six-month period of observation. Nevertheless, it is important to acknowledge that the sample size utilized in our study was limited, potentially leading to reduced statistical power and the possibility of yielding findings that do not accurately reflect reality.

Factors associated with a reduced food intake after third molar extraction among adults: a cross-sectional study

BackgroundFunctional impairment after third molar extraction may decrease the food intake. Elucidation of associated factors will contribute to a more appropriate postoperative nutritional management, and was the aim of the present study.MethodsAdults aged < 60 years who were admitted for an extraction of one or more mandibular third molars were included. Those with diabetes mellitus, anemia, metabolic diseases, mental retardation, altered dietary intake, and postoperative paralysis of the lower lip and tongue were excluded. Patient-specific risk factors were compared in relation to a decrease in the food intake on postoperative day 1. Multivariate analysis took into account the patients’ background factors.ResultsA total of 254 patients were included (median age: 26.8 ± 9.3 years, 142 women); 508 third molars were extracted. Postoperative dietary intake reduction was more common (p < 0.05) after an exclusively mandibular extraction (16.0%) than after an extraction including the maxilla (29.4%). The reduction was also more common (p < 0.05) for an extraction difficulty of Pell–Gregory class III (39.5%) than for extraction difficulties of Pell–Gregory classes I (22.6%) and II (21.3%). The reduction was also more common (p < 0.05) in patients who experienced postoperative pain (66.7%) than in those who did not (23.3%). Significant differences were observed in sex (women: 34.5%, men: 11.6%) and age (young patients [< 26 years]: 31.1%, adult patients [≥ 26 years]: 17.2%); however, no significant difference was found in terms of experiencing trismus (p < 0.11). Simple regression analysis showed significant differences between patients who did and did not have a reduced postoperative food intake depending on the sex, age, extraction site, degree of extraction difficulty, trismus, and postoperative pain. Reduced dietary intake was significantly associated with sex (odds ratio [OR]: 0.30; 95% confidence interval [CI]: 0.14–0.38), age (OR: 1.6; 95% CI: 1.0–2.5), extraction site (OR: 0.51; 95% CI: 0.31–0.83), difficulty of extraction (OR: 0.66; 95% CI: 0.50–0.88), and postoperative pain (OR: 0.12; 95% CI: 0.04–0.37).ConclusionsA younger age, female sex, extraction including the maxilla with deep implantation, and complaints of pain on postoperative day 1 were factors associated with a decreased food intake after third molar extraction.

Postoperative Dietary Intake Achievement: A Secondary Analysis of a Randomized Controlled Trial.

Sufficient postoperative dietary intake is crucial for ensuring a better surgical outcome. This study aimed to investigate the postoperative dietary intake achievement and predictors of postoperative dietary intake among gynecologic cancer patients. A total of 118 participants were included in this secondary analysis. Postoperative dietary data was pooled and re-classified into early postoperative dietary intake achievement (EDIA) (daily energy intake (DEI) ≥ 75% from the estimated energy requirement (EER)) and delay dietary intake achievement (DDIA) (DEI < 75% EER) There was a significant difference in postoperative changes in weight (p = 0.002), muscle mass (p = 0.018), and handgrip strength (p = 0.010) between the groups. Postoperative daily energy and protein intake in the EDIA was significantly greater than DDIA from operation day to discharged (p = 0.000 and p = 0.036). Four significant independent postoperative dietary intake predictors were found: preoperative whey protein-infused carbohydrate loading (p = 0.000), postoperative nausea vomiting (p = 0.001), age (p = 0.010), and time to tolerate clear fluid (p = 0.016). The multilinear regression model significantly predicted postoperative dietary intake, F (4, 116) = 68.013, p = 0.000, adj. R2 = 0.698. With the four predictors’ recognition, the integration of a more specific and comprehensive dietitian-led supportive care with individualized nutrition intervention ought to be considered to promote functional recovery.

Intracapsular coblation tonsillotomy versus extracapsular coblation tonsillectomy

BackgroundRecently, coblation technique is used in many neck surgeries; there are few studies dealing with coblation in the field of tonsillectomy either intracapsular or extracapsular tonsillectomy. The aim of this study is to evaluate the efficacy of using coblation in extracapsular tonsillectomy (preserving the capsule) over using it in intracapsular tonsillectomy (total).ResultsThere is statistically difference between results of extracapsular tonsillectomy and intracapsular tonsillectomy as regards postoperative pain according VAS scale (4.36 ± 2.413 vs 3.6 ± 2.041 with p value 0.0001). Also postoperative dietary intake and daily activity all are significantly different in extracapsular tonsillectomy and these differences were recorded after the fifth day.ConclusionExtracapsular coblation tonsillectomy has less morbidity than intracapsular coblation tonsillectomy.

Postoperative dietary intake and nutritional support among patients undergoing pancreatic surgery

Rationale: The adequate dietary intake and the effective nutritional support postoperatively consist two important components of the recovery process of the patients undergoing pancreatic surgery. The aim of this study was to record the actual energy and protein intake of the patients during the first postoperative period, as well as to assess any parenteral support given to them.

Postoperative Utilization of Oral Nutrition Supplements in Surgical Patients in US Hospitals.

Postoperative nutrition delivery is essential to surgical recovery; unfortunately, postoperative dietary intake is often poor. Recent surgical guidelines recommend use of oral nutritional supplements (ONS) to improve nutrition delivery. Our aim was to examine prevalence of coded ONS use over time and coded malnutrition rates in postoperative patients. The Premier Healthcare Database (PHD) was queried for postoperative patients found to have charges for ONS between 2008-2014. ONS use identified via charge codes. Descriptive statistics utilized to examine prevalence of malnutrition and ONS utilization. Multilevel, multivariable logistic regression models were fit to examine factors associated with ONS use. A total of 2,823,532 surgical encounters were identified in PHD in 172 hospitals utilizing ONS charge codes. ONS-receiving patients were 72% Caucasian, 65% Medicare patients with mean age of 66 ± 16.5 years. Compared with patients not receiving ONS, ONS patients had higher van Walraven severity scores (7.3 ± 7.8 vs 2.3 ± 5.6, P < .001) with greater comorbidities. Overall coded malnutrition prevalence was 4.3%. Coded malnutrition diagnosis increased from 4.4% to 5.2% during study period. Only 15% of malnourished patients received ONS. Individual hospital practice explained much of variation in early postoperative ONS use. In this large surgical population, inpatient ONS use is most common in older, Caucasian, Medicare patients with high comorbidity burden. Despite increased malnutrition during study period, observed ONS prescription rate did not increase. Our data indicate current ONS utilization in surgical patients, even coded with malnutrition, is limited and is a critical perioperative quality improvement opportunity.

Perioperative Nutritional Screening Tools Are Not Associated with Poor Outcomes After Musculoskeletal Trauma

Abstract Objectives Malnutrition is predictive of poor outcomes after trauma. Side effects of both pain and narcotics often limit postoperative dietary intake increasing nutritional deficiencies and limiting wound healing. The purpose of this study was to compare the predictive ability of a dietician nutritional evaluation and a patient reported nutritional screening tool for post-operative complications after musculoskeletal trauma. Methods Adults with operative pelvis or long bone fractures were prospectively enrolled in a single-blinded RCT and included in this analysis. Subjects were evaluated with the Patient Generated Subjective Global Assessment (PG-SGA) survey at baseline. Dietician Nutritional Assessment Screening (NAS) was performed for patients ≥65 years with low Albumin or Vitamin D, or admitted to the ICU. Complication analysis included subjects having minimum 6-month follow-up and/or ≥1 complication within six months. Spearman's Correlation was used to evaluate agreement between screening methods. Comparison using X analysis was done of complications between pre-operative assignment of malnutrition for each screening tool. Results Agreement of NAS and self-reported PG-SGA for 265 subjects demonstrated a weak correlation of rho = 0.23, P = 0.0002. Neither screening method had significant correlation for rates of non-union, mortality, medical, or surgical complications between designations of malnutrition (all P &amp;gt; .05). Among study subjects, incidence of those having a medical or surgical complication not screened by a dietician was 31.3% and 37.7% respectively. Conclusions Results indicate inconsistency in methods for assigning malnutrition in trauma population. Additionally, designation of malnutrition by either method was not associated with post-operative complication rates. The high incidence of those with a complication who were not evaluated by a dietician during initial hospitalization (1/3rd) support the need to develop better methods for screening malnutrition after trauma. Funding Sources American Academy of Orthopaedic Surgeons, Board of Specialty Societies Quality and Patient Safety Action Fund.

The Relationship Between Energy Intake and Weight Loss in Bariatric Patients.

There is a huge variation in weight loss outcomes between bariatric patients, possibly due to differences in caloric intake and changes in the amount physical activity. However, the association between the change in energy intake and weight loss has not yet been the subject of an extensive investigation. To explore the relationship between total energy intake and % total body weight loss (%TBWL) over a period of 4years post-surgery. Of the 466 patients who were asked to participate, a total 135 patients were included in this study. They all underwent bariatric surgery, 54 with primary Roux-en-Y Gastric Bypass, 43 redo Roux-en-Y gastric bypass after laparoscopic gastric banding and 38 laparoscopic sleeve gastrectomy. Pre- and post-operative dietary intake and physical activity were collected for both a weekday and a weekend day. The main analysis was performed using multiple regression analyses and was adjusted for age at surgery, BMI at baseline, obstructive sleep apnoea syndrome, type of eating behaviour, change in physical activity and protein intake (g/kg body weight). %TBWL over time, post-operative energy intake and change in physical activity did not differ between the different procedure groups (p = 0.312, p = 0.988 and p = 0.050, respectively). Change in energy intake did differ between different procedure groups (p = 0.031) and linear regression showed that this was related to total body weight loss for the fully adjusted model (β = - 0.004, p = 0.014). This study showed a higher decrease in energy intake to be related with a higher %TBWL.

Effects of postoperative dietary intake on functional recovery of patients undergoing cardiac surgery

Background and aimAmong elderly patients undergoing cardiac surgery, malnutrition is very common and related to muscle wasting known as sarcopenia. Cardiac surgery causes a further decline of nutritional status due to reduced dietary intake (DI); however, the impact of postoperative DI on functional recovery is unclear. Methods and resultsWe enrolled 250 consecutive patients undergoing cardiac surgery. Daily DI was measured between postoperative days 3 and 7. Patients were categorized as having sufficient or insufficient DI based on whether their DI met or was less than estimated total energy requirements. Functional capacity was measured using the 6-minute walking distance (6MWD) preoperatively and at discharge. Mean postoperative DI was 22.4 ± 3.0 kcal/kg/day, and postoperative DI was insufficient in 92 patients (36.8%). The prevalence of sarcopenia was not different by postoperative DI. Although there was no significant difference in preoperative 6MWD results (P = 0.65), the sufficient DI group had longer 6MWD at discharge than the insufficient DI group (P = 0.04). In multivariate regression analysis, preoperative poor nutritional status (β = −0.29), duration of surgery (β = −0.18), and postoperative DI (β = 0.40) remained statistically significant predictors for improvement of 6MWD (P < 0.0001, adjusted R2 = 0.41). ConclusionsPostoperative DI was independently associated with functional recovery, but preoperative sarcopenia was not. Regardless of preoperative nutritional status or the presence of sarcopenia, aggressive nutritional intervention in the early stage after surgery helps support functional recovery.

MON-P033: Insufficient Postoperative Dietary Intake for Total Energy Expenditure Affects Worse Functional Recovery During Acute Phase with Hip Fracture: A Multicenter Prospective Cohort Study

MON-P033: Insufficient Postoperative Dietary Intake for Total Energy Expenditure Affects Worse Functional Recovery During Acute Phase with Hip Fracture: A Multicenter Prospective Cohort Study

Low postoperative dietary intake is associated with worse functional course in geriatric patients up to 6 months after hip fracture.

We examined the relationship between postoperative dietary intake (DI) of geriatric hip fracture (HF) patients and their functional and clinical course until 6 months after hospital discharge. In eighty-eight HF patients ≥75 years, postoperative DI was estimated with plate diagrams of main meals over four postoperative days. DI was stratified as >50, >25-50, ≤25% of meals served. Functional status according to Barthel index (activities of daily living) and patients' mobility level before fracture, postoperatively, at discharge and 6 months later were assessed and related to DI levels. In-hospital complications were recorded according to clinical diagnosis. Associations were evaluated using χ2 and Kruskal-Wallis tests, and repeated-measures ANOVA and ANCOVA. Postoperatively, 28% of participants ate >50%, 43% ate >25-50% and 28% ≤25% of meals served. Irrespective of pre-fracture functional status, patients with DI ≤25% had significantly lower Barthel index scores at all times after surgery (all P50% more often had regained their pre-fracture mobility level than those with DI ≤25% at discharge (>50%: 36%; >25-50%: 10%; ≤25%: 0%; P=0·001) and 6 months after discharge (88; 87; 68%; P=0·087) and had significantly less complications (median 2 (25th-75th percentile 1-3); 3 (25th-75th percentile 2-4); 3 (25th-75th percentile 3-4); P=0·012). To conclude, geriatric HF patients had very low postoperative voluntary DI and thus need specific nutritional interventions to achieve adequate DI to support functional and clinical recovery.

P383: Low postoperative dietary intake is associated with more complications in geriatric hip fracture patients

P383: Low postoperative dietary intake is associated with more complications in geriatric hip fracture patients

PP033-MON: Low Postoperative Dietary Intake is Associated with Functional Impairment in Geriatric Patients up to 6 Months After HIP Fracture

PP033-MON: Low Postoperative Dietary Intake is Associated with Functional Impairment in Geriatric Patients up to 6 Months After HIP Fracture

Effect of Daikenchuto (TJ-100) on abdominal bloating in hepatectomized patients

To evaluate the clinical usefulness of Daikenchuto (DKT) in hepatecomized patients. Twenty patients were enrolled with informed consent. Two patients were excluded because of cancelled operations. The remaining 18 patients were randomly chosen for treatment with DKT alone or combination therapy of DKT and lactulose (n = 9, each group). Data were prospectively collected. Primary end points were Visual Analogue Scale (VAS) score for abdominal bloating, total Gastrointestinal Symptoms Rating Scale (GSRS) score for abdominal symptoms, and GSRS score for abdominal bloating. The VAS score for abdominal bloating and total GSRS score for abdominal symptoms recovered to levels that were not significantly different to preoperative levels by 10 d postoperation. Combination therapy of DKT and lactulose was associated with a significantly poorer outcome in terms of VAS and GSRS scores for abdominal bloating, total GSRS score, and total daily calorie intake, when compared with DKT alone therapy. DKT is a potentially effective drug for postoperative management of hepatectomized patients, not only to ameliorate abdominal bloating, but also to promote nutritional support by increasing postoperative dietary intake.

冠動脈バイパス手術後の非ステロイド性鎮痛剤の使用状況調査と術後感染予防に対する検討

Owing to the possibility of postoperative infections after off-pump coronary artery bypass grafting (OPCAB),early mobilization is a major aim of postoperative management.Postoperative infections and other major postoperative complications can pose a serious clinical problem.In view of this,using retrospective analysis,we investigated the number of times a non-steroidal anti-inflammatory drug (NSAID) was used up to postoperative day 3,as well as the statuses of progress of cardiac rehabilitation and dietary intake on postoperative day 3 in patients undergoing primary OPCAB (N=2citation=39)between April 2008 and November 2009.In addition,to investigate the relevance of changing Cefazolin (CEZ) to another drug in preventing postoperative infections,each patient was assigned to one of the following 2 groups : those treated with CEZ,both before and after surgery (CEZ non-replacement group) ; and those treated with antibiotics other than CEZ after surgery (CEZ replacement group).We found that the rates for accomplishment of cardiac rehabilitation step 1 and intake of more than 30 percent of dietary intake on postoperative day 3 increased as frequency of NSAID use until postoperative day 3 increased.Furthermore,significant differences were noted for number of times an NSAID was used each day until postoperative day 3,cardiac rehabilitation step and postoperative dietary intake between the CEZ non-replacement group and CEZ replacement group.These results indicate that active NSAID use was effective in achieving early cardiac rehabilitation,increasing dietary intake after OPCAB as well as in preventing postoperative infections.

Reconsideration of Postoperative Oral Intake Tolerance After Pancreaticoduodenectomy

A prospective consecutive study was planned to evaluate the postpancreaticoduodenectomy (PD) oral intake tolerance. The occurrence of delayed gastric emptying (DGE), as defined by the International Study Group of Pancreatic Surgery (ISGPS), and the amount of dietary intake were analyzed. The risk factors for low oral intake tolerance were additionally determined. The causation of DGE after PD is still unclear. Several possible factors have been discussed, such as reconstruction methods and other complications. However, none of them has followed the definition of ISGPS. Between 2003 and 2007, 101 consecutive patients underwent PD-related surgery, and standard operative procedure was performed on 85 patients. Perioperative data were prospectively collected in all patients, and the patient's postoperative dietary intake was recorded for all meals until discharge. As an indicator of early postoperative oral intake tolerance, we added up the dietary intake from postoperative day 1 to 21 and called this value the total amount of dietary intake (TDI). The postoperative outcomes were compared between non-DGE and DGE. The high-low of TDI values was also analyzed. Multivariate analysis for factors associated with the occurrence of DGE and TDI was performed. The occurrence of DGE as defined by ISGPS was 42%. The postoperative outcomes of DGE patients were significantly poor compared with those of non-DGE patients. TDI values were significantly low in DGE patients, and non-DGE patients with low TDI values showed a significantly extended duration of parenteral nutrition and postoperative hospitalization. Operative bleeding (>1,000 mL) and pancreatic fistulas were likely to be associated with DGE occurrence. Gender (women), BMI (>25 kg/m), postoperative intraabdominal infection, and DGE were significantly associated with low TDI values. The ISGPS definition of DGE seemed feasible for patient management. TDI values provided additional information for analyzing postoperative oral intake tolerance, especially when describing the differences among non-DGE patients. Substantial risk factors for low oral intake tolerance were high BMI, postoperative intraabdominal infection, and DGE.

Prospective Nonrandomized Comparison Between Pylorus-Preserving and Subtotal Stomach-Preserving Pancreaticoduodenectomy from the Perspectives of DGE Occurrence and Postoperative Digestive Functions

BackgroundTo determine the influence of pylorus preservation after pancreaticoduodenectomy, we compared the postoperative course of subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and pylorus-preserving pancreaticoduodenectomy (PPPD). MethodsA prospective, nonrandomized comparison of 77 consecutive patients undergoing PPPD (n = 37) or SSPPD (n = 40) between January 2003 and March 2007 was planned. The early postoperative course, dietary intake, and the incidence of delayed gastric emptying (DGE) were evaluated. ResultsSSPPD included significantly more cases of regional lymph node dissection (D2, PPPD 53% vs. SSPPD 80%) and portal vein resection. The median duration of surgery (457 vs. 520 min) was significantly shorter, and blood loss (619 vs. 1,235 ml) was significantly less in PPPD. Regarding postoperative clinical factors, the duration of nasogastric tube intubation (1 vs.1 day), days until solid diet (7 vs. 7 days), and the incidence of DGE (9% vs.10%) were similar in PPPD and SSPPD. However, the postoperative/preoperative body weight ratio (95% vs. 93%) was significantly higher, and the postoperative hospital stay (31 vs. 38 days) was significantly shorter in PPPD (p < 0.05). ConclusionsDespite the bias of the operative factors, the incidence of DGE and postoperative dietary intake after SSPPD was comparable with PPPD, and therefore, pylorus preservation seemed to have no impact on postoperative dietary intake or DGE.

Assessment of nutritional status in patients with rheumatoid arthritis and osteoarthritis undergoing joint replacement surgery

To evaluate pre- and postoperative nutritional status in patients with rheumatoid arthritis (RA) and osteoarthritis (OA).Preoperative dietary intake was assessed by a food frequency questionnaire, and postoperative dietary intake by food records. Anthropometric and laboratory measurements were assessed 1 day before and 10 days after surgery. Disease activity and acute response to surgery were assessed by erythrocyte sedimentation rate and G-reactive protein.The dietary intake was similar in the two groups preoperatively. Energy, protein, and fluid intake was significantly higher in the RA group postoperatively. There was a significant reduction in the concentration of hemoglobin, albumin, total protein, and ferritin in the OA group after surgery, whereas only hemoglobin concentration was reduced in the RA group.Preoperative nutritional status in the RA group was reduced as compared with preoperative nutritional status in the OA group. However, nutritional status in the RA group was less affected after joint replacement surgery compared with nutritional status in the OA group.