Postoperative Nutrition Research Articles

Efficacy of early postoperative hypocaloric supplementary parenteral nutrition in patients undergoing hepatobiliary surgery

Efficacy of early postoperative hypocaloric supplementary parenteral nutrition in patients undergoing hepatobiliary surgery

EP359 - Introduction of a pathway to improve post operative nutrition for patients undergoing a Whipple procedure - a closed loop audit

Abstract Aim Adequate nutrition in the post operative phase is an essential part of recovery following pancreaticoduodenectomy. A pathway was introduced in the regional hepatobiliary unit to standardise post operative nutrition for this patient group. Methods Three audit cycles were completed by retrospective data collection following each intervention. The first cycle was completed between March and May 2023 (n=9). The nutrition pathway was then updated so patients were on the same oral pathway regardless of whether they received parenteral nutrition or not. The second cycle was completed from May-June 2023 (n=8) and a third cycle was completed from August-October 2023 (n=7) after an education session with surgical trainees by a registered dietitian. Results Day 1 of the pathway and prescribing of CREON and supplements were consistently done well. Improvements were seen in adherence to the pathway at day 2 (22%/75%/57%) and day 3 (11%/63%/43%) post op, median number of days to establishing soft diet (from 8 to 5), median day to stopping parenteral nutrition (from 9 to 6) and median length of stay reduced from 15 to 10 days. Conclusion Adhering to a post operative nutritional pathway for patients following pancreaticoduodenectomy establishes patients on oral nutrition earlier, allowing for earlier stopping of parenteral nutrition (and thus removal of central venous access) and facilitating earlier discharge from hospital. Future work will involve re-audit with a larger cohort and incorporating education on the pathway into the biannual induction to the unit for trainees.

EP65 - Case Series of 45 Preterm Neonates with Surgical Necrotizing Enterocolitis

Abstract Aim The objective of this study was to determine if the timing of surgery from the onset of necrotising enterocolitis (NEC) diagnosis affects clinical outcomes in preterm neonates. Methods We enrolled 45 preterm neonates who were transferred to the Evelina Children’s Hospital for surgical management of NEC between 2015 and 2018. Neonates had an established diagnosis of NEC as per Bell’s staging criteria. Surgical indications were: pneumoperitoneum, failure to improve despite medical management, shock, peritonitis, abdominal mass or loops, and unresolving intestinal obstruction. Results Average time from NEC onset to surgery was 4.2 days (±9.04) for all neonates, with an average of 5.72 days (±11.42) for neonates with pneumoperitoneum and 2.05 days (±3.22) for neonates without pneumoperitoneum (p=0.09). 26 neonates (57.7%) presented with pneumoperitoneum. Time of NEC onset to surgery was inversely correlated to mortality and directly correlated to postoperative parenteral nutrition at 28 days, although neither were significant (p=0.392 and p=0.744, respectively). 6 neonates (13%) developed short gut postoperatively. Conclusions Although pneumoperitoneum is the most reliable indication for surgery, timing to operation took longer for those neonates than those without pneumoperitoneum. Longer timing to surgery was associated with lower mortality and slightly higher odds of requiring parenteral nutrition postoperatively, although not statistically significant. Though preliminary evidence suggests worse clinical outcomes for neonates with sooner surgery, more trials with larger sample sizes are needed to see if this is statistically significant.

322. IMPACT OF POSTOPERATIVE NUTRITIONAL SUPPORT MODES ON CLINICAL AND PATIENT-REPORTED OUTCOMES IN ENHANCED RECOVERY AFTER ESOPHAGECTOMY FOR CANCER

Abstract Background Enhanced Recovery After Surgery (ERAS) for esophagectomy has been demonstrated to be safe and effective. However, there is significant variation in the nutritional support treatment modes during the perioperative period. We have recently developed a novel ERAS nutritional support mode. In this study, we compared this new mode with the previous ERAS nutritional support treatment mode to assess their impact on clinical and Patient-Reported Outcomes (PROs), aiming to develop an optimal approach. Methods We enrolled 357 patients who underwent esophagectomy for esophageal thoracic cancer or esophagogastric junction cancer from June 2021 to August 2023. Two different ERAS nutritional support treatment protocols were used postoperatively: the control group previously received enteral nutrition by nasojejunal tube + parenteral nutrition + early oral diet after surgery, while the study group currently received parenteral nutrition + early oral diet. We compared the two groups in terms of clinical observation indicators, hematological analysis, serum protein changes and clinical outcomes. The comparison of quality of life on PROs was assessed using the MD Anderson Symptom Inventory. Symptom changes were analyzed using a mixed-effects model. Results A total of 324 patients successfully completed the ERAS nutritional support protocols. The success rates were 91% in the control group and 90.2% in the study group, with no statistically significant difference (p>0.05). The incidence of complications did not significantly differ between the two groups (p>0.05). Compared to the control group (n=223), the study group (n=101) significantly shortened the chest drain time (6.2±2.6 days vs. 6.6±1.5 days, p<0.05) and elevated the levels of serum total protein and albumin on the 4th postoperative day (53±5 g/L vs. 51±4 g/L, 30±2 g/L vs. 28±2 g/L, p<0.05). There were no statistically significant differences in the first flatus time, first defecation time, infusion time and postoperative hospital stay between the two groups (p>0.05). The comparison of hematological analysis, serum protein changes, changes in body weight during the perioperative period and 30-day readmission rate showed no statistically significant differences (p>0.05). In the MD Anderson Symptom Inventory, the study group had significantly better scores in sadness, dry mouth, enjoyment of life, and general activity dimensions compared to the control group (p=0.013, p<0.001, p=0.045, p=0.008). Conclusion Based on the similar rehabilitation outcomes, the simplified ERAS nutritional support treatment mode without postoperative enteral nutrition by nasojejunal tube is more optimized because it is physiological sound and significantly improves quality of life on PROs.

Nomogram for predicting intolerable postoperative early enteral nutrition following definitive surgery for small intestinal fistula: a cohort study.

This study was designed to develop and validate a nomogram for predicting intolerable early enteral nutrition (EEN) following definitive surgery (DS) for small intestinal fistula. A total of 377 patients, recruited from January 2016 to September 2023, was randomly allocated into development ( n =251) and validation ( n =126) groups in a 2:1 ratio. Risk factors were identified using the nomogram. Its performance was assessed based on calibration, discrimination, and clinical utility, with validation confirming its effectiveness. Of the 377 patients, 87 (23.1%) were intolerant to EEN, including 59 (23.1%) in the development cohort and 28 (22.1%) in the validation cohort ( P =0.84). Four factors were identified as predictive of intolerable EEN: severe abdominal adhesion, deciliter of blood loss during DS, human serum albumin (Alb) input >40g during and within 48h post-DS, and the visceral fat area (VFA)/total abdominal muscle area index (TAMAI) ratio. The model demonstrated excellent discrimination, with a C-index of 0.79 (95% CI: 0.74-0.87, including internal validation) and robust calibration. In the validation cohort, the nomogram showed strong discrimination (C-index=0.77; 95% CI: 0.64-0.87) and solid calibration. Decision curve analysis affirmed the nomogram's clinical utility. This research introduces a nomogram that enables the individualized prediction of intolerable EEN following DS for small intestinal fistula, demonstrating a possible clinical utility.

Implementing early feeding after liver transplant using implementation frameworks: A multimethod study.

Evidence-based guidelines (EBGs) in the nutritionmanagement of advanced liver disease and enhanced recovery after surgery recommendations state that normal diet should recommence 12-24 h following liver transplantation. This study aimed to compare postoperative nutrition practices to guideline recommendations, explore clinician perceptions regarding feeding after transplant surgery, and implement and evaluate strategies to improve postoperative nutrition practices. A pre-post multimethod implementation study was undertaken, guided by the knowledge-to-action framework. A retrospective chart audit of postoperative dietary practice and semistructured interviews with clinicians were undertaken. Implementation strategies were informed by the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool and then evaluated. An evidence-practice gap was identified, with the median day to initiation of nutrition (free-fluid or full diet) on postoperative day (POD) 2 and only 25% of patients aligning with the EBGs. Clinician interviews identified belief in the importance of nutrition, with variation in surgical practice in relation to early nutrition, competing clinical priorities, and vulnerabilities in communication contributing to delays in returning to feeding. An endorsed postoperative nutrition protocol was implemented along with a suite of theory- and stakeholder-informed intervention strategies. Following implementation, the median time to initiate nutrition reduced to POD1 and alignment with EBGs improved to 60%. This study used implementation frameworks and strategies to understand, implement, and improve early feeding practices in line with EBGs after liver transplant. Ongoing sustainability of practice change as well as the impact on clinical outcomes have yet to be determined.

Temporary diverting loop ileostomy in Crohn's disease surgery; indications and outcome.

Crohn's disease can present with complex surgical pathologies, posing a significant risk of morbidity and mortality for patients. The implementation of a loop ileostomy for selected patients may help minimize associated risks. In this retrospective cohort study, we investigated the utilization of temporary fecal diversion through the creation of a loop ileostomy in Crohn's surgery. Closure of all ostomies involved a hand-sewn single-layer technique. We then conducted bivariate analysis on 30-day outcomes for closures, focusing on favorable recovery defined as the restoration of bowel continuity without the occurrence of two challenges in recovery: newly developed organ dysfunction or the necessity for reoperation. In total, 168 patients were included. The median age of the patients was 38 years (IQR 27-51). The most common indication for a loop ostomy was peritonitis (49%). After ileostomy closure, 163 patients (97%) achieved favorable recovery, while five encountered challenges; four (2.4%) underwent abdominal surgery, and one (0.6%) developed acute renal failure requiring dialysis. Two patients (1.2%) had a re-creation of ileostomy. Patients encountering challenges were older (56 [IQR 41-61] vs. 37 [IQR 27-50]; p 0.039) and more often required secondary intention wound healing (40% vs. 6.7%; p 0.049) and postoperative parenteral nutrition following their index surgery (83% vs. 26%; p 0.006). Selectively staging the Crohn's disease operations with a loop ileostomy is a reliable practice with low morbidity and high restoration rates of bowel continuity. Our hand-sewn single-layer technique proves effective in achieving successful surgical recovery.

Greater Post-Operative Nutrition Risks Identified in Pediatric and Adolescent Patients after Anterior Cruciate Ligament Reconstruction Regardless of Age and Sex.

Systematic detection of risky nutrition behaviors after sports surgery may better promote healing for return-to-sport. The purpose of this study was to assess nutritional behavior differences between patients following anterior cruciate ligament reconstruction (ACLR) and following other lower-extremity orthopedic surgeries. One pediatric sports medicine center was reviewed for a custom Sports Nutrition Assessment for Consultation, which investigates nutrition-related risk factors for youth athletes at their first post-operative visit. Patients reported "Yes" or "No" to eight questions, after which they were offered a nutrition consultation for any response indicating risk. A total of 243 post-ACLR and 242 non-ACLR patients were reviewed. The post-ACLR patients more often reported a change in appetite (p = 0.021), recent weight changes (p = 0.011), a desire to better understand nutrition (p = 0.004), and recommendations to change their body composition (p = 0.032). More post-ACLR patients were identified for a nutrition consultation (p = 0.002), though an equal percentage accepted the consultation between groups. Age and sex were not determined to be significant confounders after matched sub-analysis. The post-ACLR patients more often reported nutrition risks, specifically weight-related issues, regardless of age or sex. Sports surgeons should regularly inquire about nutrition-related concerns with patients and refer to sports dietitians for recovery nutrition support as needed, particularly after ACLR.

Postoperative prognostic nutrition index predicts survival in patients with small bowel adenocarcinoma after surgical resection.

Surgical resection (SR) is the main treatment for small bowel adenocarcinoma (SBA), but it increases metabolic demand, systemic inflammation, and digestive dysfunction, resulting in major impacts on the postoperative outcomes of patients. In this study, we aimed to investigate the role of the postoperative prognostic nutritional index (PNI), a surrogate marker of inflammation and nutrition, in patients with SBA after resection. From June 2014 to March 2022, 44 consecutive patients who underwent SR for SBA in Taipei Veterans General Hospital were retrospectively reviewed. Factors associated with survival including PNI were analyzed. PNI decreased in patients after SR for SBA (median change: -1.82), particularly in those who underwent Whipple operation or developed postoperative pancreatic fistula. Postoperative PNI <45.2 best predicted overall survival (OS) (area under the receiver operating characteristic curve [AUROC]: 0.826, p = 0.001). Patients with lower postoperative PNI had significantly worse OS compared to those with higher postoperative values (median OS: 19.3 months vs not reached, p < 0.001). Low postoperative PNI (hazard ratio [HR]: 11.404, p = 0.002), tumoral lymphovascular invasion (HR: 8.023, p = 0.012), and adjuvant chemotherapy (HR: 0.055, p = 0.002) were independent risk factors for OS. Postoperative PNI also significantly predicted recurrence-free survival independent of lymphovascular invasion and adjuvant chemotherapy (HR: 6.705, p = 0.001). PNI commonly decreases in patients with SBA who undergo Whipple surgery or develop postoperative pancreatic fistula. Postoperative PNI independently predicts survival and may serve as a clinical marker to optimize patient outcomes.

Causes of Poor Incision Healing after Caesarean Section and Strategies to Prevent it

This study aims to investigate the causes of poor healing of uterine incision after caesarean section and the prevention and treatment strategies. By retrospectively analysing the clinical data of 800 patients who underwent new cesarean section between January 2021 and January 2023 in our hospital, it provides reference for improving the quality of healing. Methods: The clinical data of 800 patients with poor healing of uterine incision after cesarean section were retrospectively analysed, and the relevant influencing factors and prevention methods were summarised. Results：Factors affecting the healing of uterine incision after new type of cesarean section included age, body mass index, pregnancy and delivery, operation time, intraoperative bleeding, postoperative infection and nutritional status. Treatment included strengthening postoperative nutrition, preventing infection, and regular dressing changes. Most of the patients achieved good healing and no abnormality was seen at 2-month follow-up. Conclusion: Poor healing of uterine incision after new-style cesarean section is related to many factors, but the incidence can be reduced by preoperative preparation and postoperative care. For the poor healing that has occurred, timely and correct treatment measures can help promote incision healing and reduce complications. Attention should be paid to related factors and preventive and therapeutic measures should be taken to improve the quality of healing. It is also crucial to strengthen the training of healthcare professionals and rehabilitation exercises for patients.

Factors affecting dietary progression post cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC)

Background & AimsPeritoneal carcinomatosis (PC) is treated by cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Timely postoperative nutrition is required to reduce the risk of malnutrition and other complications; thus the present study aims to evaluate factors that may impact dietary progression following CRS/HIPEC treatment. MethodsForty-two patients undergoing CRS/HIPEC at a tertiary hospital were audited between April 2019 and August 2020. Patients were classified into two groups: fast dietary progression (FDP) and slow dietary progression (SDP), based on commencement of a full fluid diet (FF) within 7 days or after 7 days postoperatively. Between-group differences in patient characteristics, surgical factors and postoperative complications were evaluated statistically (significant at p<0.05). ResultsFDP and SDP groups comprised of 22 (52%) and 20 (40%) patients, respectively. A FF diet was established on a median of 7 (4.25 - 9.75) days, but not before day 2. Nineteen of the 31 (61.3%) patients receiving parenteral nutrition (PN) were in the SDP group (p = 0.009). The SDP group had longer surgery duration (p = 0.05), more gastrointestinal anastomoses (GIAs) (p = 0.02), more enterotomies (p = 0.008), higher rates of prolonged ileus (p = 0.007), longer duration to first bowel motion (p = 0.002), more returns to theatre (p = 0.03), higher Clavien Dindo scores ≥ IIIb (p = 0.01) and longer postoperative length-of-stay (p = 0.001), compared to the FDP group. ConclusionsPostoperative complications were associated with SDP in PC patients undergoing CRS/HIPEC. Strategies that aim to limit SDP through timely commencement of nutrition, including PN, are important to improve postoperative outcomes in this patient group.

Comparing the antireflux effect of laparoscopic proximal gastrectomy with double-flap technique reconstruction versus laparoscopic total gastrectomy with Roux-en-Y reconstruction for proximal early gastric cancer: study protocol for a multicentre, prospective, open-label, randomised controlled trial

IntroductionLaparoscopic proximal gastrectomy with double flap technique (LPG-DFT) reconstruction has been used for proximal early gastric cancer in recent years. However, its feasibility and safety remain uncertain, as only a...

Short-term and long-term outcomes of transduodenal ampullectomy for patients with early ampullary cancer.

e16244 Background: Transduodenal ampullectomy (TDA) has been attempted in early ampullary cancer. However, the indication and extent of TDA with curative intent remain controversial. Here, we address the perioperative and long-term outcomes of patients with early ampullary cancer who underwent TDA. Methods: Ten early ampullary cancer patients who underwent TDA and 11 early ampullary cancer patients who underwent subtotal stomach-preserving pancreatoduodenectomy (SSPPD) at this institute were respectively enrolled. Among this cohort, we analyzed the perioperative outcomes and long-term outcomes. Results: In terms of the perioperative outcomes between the TDA and SSPPD groups, the TDA group exhibited a shorter operating time (244 minutes vs. 390 minutes, p = 0.003), less intraoperative blood loss (67.5 grams vs. 774 grams, p = 0.006) and shorter length of postoperative hospital stay (15 days vs. 33 days). With respect to the postoperative nutrition status, the TDA group exhibited less postoperative weight loss (0.67% vs. 8.95%, p = 0.021), a better CONUT score (1.0 vs. 2.1, p = 0.011) and a better PNI score (42.9 vs. 40.9, p = 0.018). The 5-year survival rate in the adenoma with high-grade dysplasia (HGD) and T1a (M) groups was 100%, while the median survival time in the T1a (OD) group was 20.7 months (p = 0.0028). Conclusions: TDA is assumed to be a feasible and effective surgical procedure for the treatment of selected patients with early ampullary cancer, including patients with adenoma with HGD or T1a (M) ampullary cancer.

Relationship between the perioperative prognostic nutritional index and postoperative gait function in elderly hip fractures

ObjectivesWe investigated the relationship between the perioperative nutritional status and postoperative walking ability in patients with hip fractures. MethodsWe included 246 surgically treated elderly patients with hip fractures who were ambulatory before the injury. Patients were divided into two groups: group A, who were able to walk at discharge, and group B, who were unable to walk at discharge. We pair-matched these two groups according to age, preoperative subdivided walking ability, and fracture site to form groups A′ and B'. The prognostic nutritional index (PNI; PNI = 10 × serum albumin (g/dL) + 0.005 × blood total lymphocyte count (/mm³)) before surgery and 1 day, 1 week, and 2 weeks after surgery and energy intake 1 and 2 weeks after surgery were compared. ResultsAfter adjustments for age, preoperative subdivided walking ability, and fracture site, there were 51 patients in group A' (mean age 84.6 years) and 51 patients in group B' (mean age 84.7 years). In group A'/group B′, PNI was 43.38/42.60 (P = 0.19) before surgery, 33.87/33.31 (P = 0.44) 1 day after surgery, 34.99/32.35 (P = 0.01) 1 week after surgery, and 37.33/35.69 (P = 0.15) 2 weeks after surgery. Energy intake was 1380.8/1203.1 kcal (P = 0.01) 1 week after surgery and 1382.0/1335.6 kcal (P = 0.60) 2 weeks after surgery. ConclusionsPNI and energy intake at 1 week postoperatively were associated with early postoperative nutrition and the recovery of walking ability.

The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial.

Leak following surgical repair of traumatic duodenal injuries results in prolonged hospitalization and oftentimes nil per os(NPO) treatment. Parenteral nutrition(PN) has known morbidity; however, duodenal leak(DL) patients often have complex injuries and hospital courses resulting in barriers to enteral nutrition(EN). We hypothesized EN alone would be associated with 1)shorter duration until leak closure and 2)less infectious complications and shorter hospital length of stay(HLOS) compared to PN. This was a post-hoc analysis of a retrospective, multicenter study from 35 Level-1 trauma centers, including patients >14 years-old who underwent surgery for duodenal injuries(1/2010-12/2020) and endured post-operative DL. The study compared nutrition strategies: EN vs PN vs EN + PN using Chi-Square and Kruskal-Wallis tests; if significance was found pairwise comparison or Dunn's test were performed. There were 113 patients with DL: 43 EN, 22 PN, and 48 EN + PN. Patients were young(median age 28 years-old) males(83.2%) with penetrating injuries(81.4%). There was no difference in injury severity or critical illness among the groups, however there were more pancreatic injuries among PN groups. EN patients had less days NPO compared to both PN groups(12 days[IQR23] vs 40[54] vs 33[32],p = <0.001). Time until leak closure was less in EN patients when comparing the three groups(7 days[IQR14.5] vs 15[20.5] vs 25.5[55.8],p = 0.008). EN patients had less intra-abdominal abscesses, bacteremia, and days with drains than the PN groups(all p < 0.05). HLOS was shorter among EN patients vs both PN groups(27 days[24] vs 44[62] vs 45[31],p = 0.001). When controlling for predictors of leak, regression analysis demonstrated EN was associated with shorter HLOS(β -24.9, 95%CI -39.0 to -10.7,p < 0.001). EN was associated with a shorter duration until leak closure, less infectious complications, and shorter length of stay. Contrary to some conventional thought, PN was not associated with decreased time until leak closure. We therefore suggest EN should be the preferred choice of nutrition in patients with duodenal leaks whenever feasible. IV.

Motivational Interviewing improves postoperative nutrition goals within the Enhanced Recovery after Surgery (ERAS®) pathway in elective bowel surgery – A randomized clinical pilot trial

Exploration whether Motivational Interviewing (MI) could be learned and implemented with ease within a surgical in-hospital setting and whether participation in the intervention led to significantly higher compliance with ERAS®-recommended protein intake goals. The individual healing process of many patients is delayed because they fail to cover their calorie requirement, which could be counteracted by a patient-centered conversational intervention that is new in perioperative practice. This patient-blinded pilot-RCT included 60 patients (≥18 years) following the certified ERAS® bowel protocol for colorectal surgery between March and August 2022. Five perioperative MI interventions were conducted by two health employees certified to perform MI. Key endpoints were the number of protein shakes drunk, calories of proteins ingested and overall calorie intake. A total of 60 patients (34 men [56.7%]; mean [SD] age, 60.7 [13.3] years) were randomized. MI patient-group had significantly higher protein shake intake on all postoperative days except day 3. For days 0-3 MI group drank significantly more shakes overall (median 5.5 vs. 2.0; P=0.004) and consumed more calories (median 1650.0 vs. 600.0kcal; P=0.004) and proteins (median 110.0 vs. 40.0g; P=0.005). Total calorie intake for each day by shakes and dietary intake was significantly higher in the MI-intervention group on day 2 (mean 1772.3 vs. 1358.9kcal; P= 0.03). MI may contribute to improve compliance with nutritional goals in the certified ERAS® protocol by increasing protein and calorie intake. The findings suggest further investigation of MI to help patients achieve their perioperative nutrition goals in different clinical settings. DRKS - Deutsches Register Klinischer Studien; DRKS-ID: DRKS00027863; https://drks.de/search/de/trial/DRKS00027863.

Clinical application of real-time continuous glucose monitoring system during postoperative enteral nutrition therapy in esophageal cancer patients.

Enteral nutrition (EN) support therapy increases the risk of abnormal blood glucose (BG). The aim of this study is to evaluate the clinical value of a real-time continuous glucose monitoring (rt-CGM) system in BG monitoring during postoperative EN support therapy in patients with esophageal cancer. Patients without diabetes mellitus (DM) with esophageal cancer who planned to receive postoperative EN were enrolled. With the self-monitoring of BG value as the reference BG, the accuracy of rt-CGM was evaluated by the mean absolute relative difference (MARD) value, correlation efficient, agreement analysis, and Parkes and Clarke error grid plot. Finally, paired t tests were used to compare the differences in glucose fluctuations between EN and non-EN days and slow and fast days. The total MARD value of the rt-CGM system was 13.53%. There was a high correlation between interstitial glucose and fingertip capillary BG (consistency correlation efficient = 0.884 [95% confidence interval, 0.874-0.894]). Results of 15/15%, 20/20%, 30/30% agreement analysis were 58.51%, 84.71%, and 99.65%, respectively. The Parkes and Clarke error grid showed that the proportion of the A and B regions were 100% and 99.94%, respectively. The glucose fluctuations on EN days vs non-EN days and on fast days vs slow days were large, and the difference was statistically significant (P < 0.001). The rt-CGM system achieved clinical accuracy and can be used as a new option for glucose monitoring during postoperative EN therapy. The magnitude of glucose fluctuation during EN therapy remains large, even in the postoperative population without DM.

Evaluation of pre- and postoperative nutrition and oral health–related quality of life in orthognathic surgery patients

ObjectiveOrthognathic surgery is a complex orofacial surgery that can significantly impact occlusal function and effect nutritional and quality of life parameters. This study aimed to evaluate alterations in dietary intake, chewing function, physical activity, and oral health–related quality of life of patients undergoing orthognathic surgery. Research Methods and ProceduresIn this prospective longitudinal study, the assessments were conducted at: preoperatively (T0) and postoperative first week (T1), second week (T2), first month (T3), and third month (T4) between May 2021 and March 2023. Sociodemographic questionnaire, 24-h dietary recall record, chewing ability form, International Physical Activity Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) was applied at face-to-face interviews. ResultsSeventy eligible orthognathic surgery patients were evaluated, and 37 patients (52.8%) completed this study. Energy and fat intake significantly decreased from T0 to T1 (P < 0.001) and returned to basis by T4 (P = 0.015). Fiber intake was found to be lowest at T1 and T2 compared with other time points (P < 0.001). Chewing ability showed a deterioration and then improvement; however, patients still had difficulties chewing hard foods at T4. The OHIP-14 increased at T2 and T3 from T0 (P < 0.001 and P = 0.021, respectively) and showed a significant improvement at T4 (P < 0.05). ConclusionThe findings indicate a temporary decline in nutritional intake and chewing ability with subsequent recovery by the third month postsurgery. These changes, along with the trends in oral health-related quality of life, underscore the need for tailored nutritional and functional rehabilitation programs following orthognathic surgery.

Malnutrition in emergency general surgery: a survey of National Emergency Laparotomy Audit Leads.

Patients who are malnourished and have emergency general surgery, such as a laparotomy, have worse outcomes than those who are not malnourished. It is paramount to identify these patients and minimise this risk. This study aimed to describe current practices in identifying malnutrition in patients undergoing a laparotomy, specifically focusing on screening, assessment, nutrition pathways and barriers encountered by clinicians. Following piloting and validity assessment, anaesthetic and surgical National Emergency Laparotomy Audit (NELA) Leads at hospitals across England and Wales were emailed an invitation to a survey. Responses were gathered using Qualtrics. Descriptive analysis and correlation with laparotomy volume and professional role were performed in SPSSv26. University of Sheffield ethical approval was obtained (UREC 046205). The results from the survey are reported according to the CHERRIES guidelines. The survey was completed by 166/289 NELA Leads from 117/167 hospitals (57.4% and 70.1% response rates, respectively). Participants reported low rates of nutritional screening (42/166; 25.3%) and assessment (26/166; 15.7%) for malnutrition preoperatively. More than one third of respondents (40.1%) had no awareness of local screening tools; indeed, the Malnutrition Universal Screening Tool (MUST) was used by approximately half of respondents (56.6%). Contrary to guidelines, NELA Leads report albumin levels continue to be used to determine malnutrition risk (73.5%; 122/166). Postoperative nutrition pathways were common (71.7%; 119/166). Reported barriers to nutritional screening and assessment included a lack of time, training and education, organisational support and ownership. Participants indicated nutrition risk is inadequately identified and is an important missing data item from NELA. There was no significant correlation with hospital laparotomy volume in relation to screening or assessment for malnutrition, the use of nutritional support pathways or organisational barriers. There was interprofessional agreement across a number of domains, although some differences did exist. Wide variation exists in the current practice of identifying malnutrition risk in NELA patients. Barriers include a lack of time, knowledge and ownership. Nutrition pathways that encompass the preoperative phase and incorporation of nutrition data in NELA may support improvements in care.

Feeding Jejunostomy in Pancreatico-Duodenectomy patients: Is it important

BackgroundDuring a pancreaticoduodenectomy, Feeding Jejunostomy (FJ) is frequently placed to improve postoperative nutrition. Our aim is to ascertain the effects of the FJ tube after pancreaticoduodenectomy. MethodsProspective analysis was performed on all patients who underwent concurrent FJ after pancreaticoduodenectomy (Whipples surgery) between 2022 and 2023. On POD 1, FJ feeds were frequently initiated. After the patient had taken enough oral feeds, the jejunostomy feeds were stopped. Frequency and mean were used to represent the data. ResultsA total of 48 patients underwent pancreaticoduodenectomy with concomitant FJ. A total of 35 (72.9%) were men and the mean age was 49.2 years. The majority (28, 58.3 %) of these patients had cancer head of the pancreas as an indication for surgery. Only 13 out of 48 (27%) patients required nutrition supplementation through FJ on POD 10. Only 1 out of 48 (2%) patients required FJ feeds on POD 30. None of these patients had tube-related complications in the 30-day postoperative period. There was a single FJ-related mortality in the 30-day postoperative period due to pulmonary embolism. The patients, who required prolonged FJ feeds had grade C pancreatic leaks, delayed gastric emptying, and surgical site infection. ConclusionThe routine use of concurrent FJ in patients undergoing pancreaticoduodenectomy has a good outcome, especially for those who require prolonged postoperative nutritional supplementation because of grade c pancreatic leak and delayed gastric emptying.