Preoperative Nutritional Assessment Research Articles

Examining the relationship between preoperative nutritional and symptom assessment and postoperative atrial fibrillation in esophageal squamous cell carcinoma patients: a retrospective cohort study

ObjectiveThe study aimed to examine the relationship between preoperative nutritional status, symptom burden, and the occurrence of postoperative atrial fibrillation in Esophageal Squamous Cell Carcinoma patients.MethodsThe study, conducted in the Department of Thoracic Surgery at the Affiliated Huai’an No. 1 People’s Hospital of Nanjing Medical University, applied the NRS 2002, SGA and MSAS scoring systems as measures of nutritional status and symptom occurrence in patients diagnosed with ESCC. Univariate and multivariate logistic regression analysis were performed to evaluate the association between nutritional scores, symptom scores, and postoperative complications.ResultsThe research found a significant correlation between high MSAS scores and postoperative atrial fibrillation. Patients with high symptom burden also tended to have nutritional risk or malnutrition according to the NRS2002 and SGA scores.ConclusionThere is a need for healthcare providers to pay attention to ESCC patients’ physical and psychological symptoms. Close monitoring of nutritional status and timely nutritional interventions should be integrated into these patients’ care plans as they have been found to be related to postoperative complications such as atrial fibrillation.

FP2.2 - Does preoperative nutritional assessment correlate with postoperative outcomes of patients undergoing surgery due to colorectal cancer? A bicenter prospective observational study

Abstract Aims Preoperative nutritional status has been investigated as a risk factor for postoperative complications in patients undergoing surgery due to colorectal surgery. The aim of the present study was to investigate the predictive role of preoperative nutritional assessment in terms of morbidity and mortality in such patients. Methods Patients undergoing surgery due to colorectal cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Patient-Generated Subjective Global Assessment (PG-SGA) tool and the Geriatric Nutritional Risk Index (GNRI) tool. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 159 patients with a mean age of 69 ± 12 years old. Severe malnutrition according to the PG-SGA tool was associated with advanced disease stage (66% vs 59%, p=0.006). In addition, the high risk of malnutrition according to the GNRI tool was correlated to major (Clavien-Dindo≥3) postoperative complications (19% vs 15%, p=0.026) and increased 30-day mortality (34% vs 9%, p=0.026). Conclusions Postoperative morbidity and mortality of patients undergoing surgery due to colorectal cancer seem to be associated with preoperative nutritional stratification, especially with the high malnutrition risk.

ThP4.9 - The role of preoperative nutritional assessment in postoperative outcomes of hepato-pancreato-biliary patients: A bicenter prospective observational study

Abstract Aims Preoperative nutritional status of patients who undergo surgery due to hepato-pancreato-biliary (HPB) cancer has been considered as a prognostic factor of their postoperative course. The aim of the present study was to investigate the association of preoperative nutritional assessment with the postoperative morbidity and mortality in such patients. Methods Patients undergoing surgery due to HPB cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Global Leadership Initiative on Malnutrition (GLIM) criteria and the Controlling Nutritional Status (CONUT) score. The present study was registered in ClinicalTrials.gov (NCT05795374). Results The present study included 66 patients with a mean age of 63 ± 12 years old. The high risk of malnutrition according to the GLIM criteria was associated with major (Clavien-Dindo≥3) postoperative complications (74% vs 32%, p=0.026) and increased 30-day mortality (80% vs 23%, p=0.021). Moreover, malnutrition according to the CONUT tool was correlated to increased 30-day mortality (66% vs 45%, p=0.016). Conclusions Preoperative malnutrition seems to be associated with higher rates of postoperative mortality and major morbidity in patients undergoing surgery due to HPB cancer.

Comparison between AWGC-cachexia and GLIM-malnutrition in patients with gastric cancer

BackgroundThe newly released Asian Working Group for Cachexia (AWGC) criteria share similar diagnostic items with the Global Leadership Initiative on Malnutrition (GLIM) criteria. This study aims to compare the AWGC cachexia and GLIM malnutrition in patients with gastric cancer and investigate whether one diagnosis continues to be a prognostic factor in individuals diagnosed with the other condition. MethodsData of patients who underwent radical gastrectomy for gastric adenocarcinoma were prospectively collected from 2013 to 2019. The AWGC and GLIM criteria were applied to diagnosis cachexia and malnutrition, respectively. Univariate and multivariate logistic and Cox regression were used to verify the effect of relevant factors on postoperative complications and overall survival. ResultsA total of 1420 patients were included, among whom 174 (12.3 %) were diagnosed with AWGC-cachexia alone, 85 (6.0 %) were diagnosed with GLIM-malnutrition alone, and 324 (22.8 %) had both AWGC-cachexia and GLIM-malnutrition. Both AWGC-cachexia and GLIM-malnutrition were independent risk factors for complications and overall survival. When they coexisted, the odds ratios (OR) and hazard ratios (HR) tended to be higher. In the AWGC-cachexia subset, GLIM-malnutrition remained an independent risk factor (HR = 1.544, 95 % CI = 1.098–2.171, P = 0.012) for overall survival after the adjustment of confounding factors. Similarly, in the GLIM-malnutrition subset, AWGC-cachexia remained an independent risk factor for overall survival (HR = 1.697, 95 % CI = 1.087–2.650, P = 0.020). Patients with both cachexia and malnutrition had the worst overall survival. ConclusionAWGC-cachexia and GLIM-malnutrition criteria were two non-redundancy tools in reflecting mortality risk in preoperative nutritional assessment.

Preoperative nutritional assessment by using subjective and objective criteria and its implication in the outcome of cancer patients undergoing abdomino-pelvic surgeries

The World Health Organization (WHO) defines “nutritional status” as the condition of the body resulting from the intake, absorption, and utilization of nutrients and the influence of particular physiological and pathological status.[1] Globally, malnutrition affects a significant proportion of individuals, with prevalence rates ranging from 30% to 85%, particularly prevalent among patients with gastric, pancreatic, lung, prostate, and colon cancers.[2] In cancer patients, malnutrition is associated with decreased treatment tolerance, increased postoperative morbidity and mortality, and diminished quality of life [3]The evaluation of nutritional status in cancer patients commonly relies on subjective methods such as the Patient-Generated Subjective Global Assessment (PG-SGA)[4] and objective measures like anthropometry and biochemical parameters[5]. Despite their widespread use, no single method is universally accepted as the "gold standard," each possessing its’ inherent limitations.

Malnutrition in total joint arthroplasty: what should the orthopaedic surgeon consider?

Total joint arthroplasty (TJA) is rising globally, with an associated increase in associated complications, necessitating increased efforts in prevention of these complications with pre-operative optimisation. Malnutrition has been highlighted as one of the most important pre-operative modifiable risk factors to be addressed in TJA, with the term malnutrition in orthopaedic surgery having a broad definition that encompasses a wide range of nutritional abnormalities from undernutrition to overnutrition contributing to the outcomes of TJA. Complications associated with malnutrition include periprosthetic joint infection (PJI), periprosthetic fracture, dislocations, aseptic loosening, anaemia, prolonged length of stay (LOS), increased mortality, and raised health care costs. Standardised nutritional scoring tools, anthropometric measurements, and serological markers are all options available in pre-operative nutritional assessment in TJA, but there is no consensus yet regarding the standardisation of what parameters to assess and how to assess them. Abnormal parameters identified using any of the assessment methods results in the diagnosis of malnutrition, and correction of these parameters of overnutrition or undernutrition have shown to improve outcomes in TJA. With the multiple nutritional parameters contributing to the success of total joint arthroplasty, it is imperative that orthopaedic surgeon has a thorough knowledge regarding nutritional peri-operative optimisation in TJA.

Chinese expert consensus on perioperative nutritional support for elderly surgical patients (2024)

The increasing aging population in China leads to an increase in the number of elderly patients undergoing surgical procedures. Elderly patients are characterized with conditions such as multiple comorbidities, high nutritional risk, frailty, decreased organ function, etc. Nutritional support is one of the most significant elements in the perioperative period of elderly surgical patients. Currently, there is a lack of guidelines or expert consensus on nutritional support. To promote the standardized development of clinical work in this field, the Geriatric Surgery Professional Committee of the Chinese Research Hospital Association gathered experts and formulated relevant recommendations for perioperative nutritional therapy for elderly surgical patients based on existing research evidence. This consensus included several parts: preoperative nutritional assessment, indications, goals, ingredients and approaches of perioperative nutritional support, nutritional complications and management, nutritional intervention for surgical complications, and nutritional follow-up. It is expected to provide valuable suggestions for standardizing nutritional support for elderly surgical patients.

Perioperative nutrition optimization: a review of the current literature†

Abstract Objective This article aims to elaborate the recent research status of perioperative nutrition optimization, in order to help clinical practice. Methods This study employed a comprehensive and systematic method to search prominent databases, including PubMed and Web of Science, using carefully selected keywords. Following meticulous screening, the inclusion of high-quality studies was prioritized, and a thorough review of the references was conducted to comprehensively analyze the latest evidence on perioperative nutrition optimization. Results The main contents include preoperative nutritional risk screening and assessment, nutritional support pathway, immune enhancing nutrition, preoperative and postoperative nutritional management, as well as personalized nutrition optimization strategies for specific populations (such as children, bariatric surgery patients, and cancer patients). Conclusions In clinical practice, the importance of perioperative nutrition should be emphasized, and personalized nutrition management plans should be developed based on the characteristics and needs of patients. Further research and promotion of perioperative nutrition optimization strategies will help improve the overall prognosis and quality of life of surgical patients.

Baseline 25(OH)D level is a prognostic indicator for bariatric surgery readmission: a matched retrospective cohort study.

Managing postsurgical complications is crucial in optimizing the outcomes of bariatric surgery, for which preoperative nutritional assessment is essential. In this study, we aimed to evaluate and validate the efficacy of vitamin D levels as an immunonutritional biomarker for bariatric surgery prognosis. This matched retrospective cohort study included adult patients who underwent bariatric surgery at a tertiary medical center in China between July 2021 and June 2022. Patients with insufficient and sufficient 25(OH)D (< 30 ng/mL) were matched in a 1:1 ratio. Follow-up records of readmission at 3 months, 6 months, and 1 year were obtained to identify prognostic indicators. A matched cohort of 452 patients with a mean age of 37.14 ± 9.25 years and involving 69.47% females was enrolled. Among them, 94.25 and 5.75% underwent sleeve gastrectomy and gastric bypass, respectively. Overall, 25 patients (5.54%) were readmitted during the 1-year follow-up. The prognostic nutritional index and controlling nutritional status scores calculated from inflammatory factors did not efficiently detect malnourishment. A low 25(OH)D level (3.58 [95% CI, 1.16-11.03]) and surgery season in summer or autumn (2.68 [95% CI, 1.05-6.83]) increased the risk of 1-year readmission in both the training and validation cohorts. The area under the receiver operating characteristic curve was 0.747 (95% CI, 0.640-0.855), with a positive clinical benefit in the decision curve analyses. The relationship between 25(OH)D and 6-month readmission was U-shaped. Serum 25(OH)D levels have prognostic significance in bariatric surgery readmission. Hence, preferable 25(OH)D levels are recommended for patients undergoing bariatric surgery.

The relationship between baseline nutritional status with subsequent parenteral nutrition and clinical outcomes in cancer patients undergoing cytoreductive surgery: a retrospective study.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC) with Cytoreductive Surgery (CRS) is the preferred treatment for peritoneal malignancies. This highly complex operation is associated with a high incidence of complications, particularly due to malnutrition. This study aimed to investigate the potential association between preoperative nutritional status and postoperative clinical outcomes in adult cancer patients who underwent CRS/HIPEC for peritoneal malignancy. A retrospective study with 140 adult cancer patients, on parenteral nutrition (PN) (n = 40) and not on PN (n = 100) who underwent CRS with or without HIPEC, was conducted. Patients who received PN had significantly longer post-operative, hospital, and ICU LOS than those who did not (p = 0.001). ICU admission was significantly higher in the non-PN receiving group compared to the PN receiving group. When compared to the PN group, the majority of patients not receiving PN were at low risk of malnutrition (91% vs. 75%, p = 0.020), whereas 17.5% of PN patients were at risk of malnutrition during hospitalization. Multiple regression analyses revealed a strong positive relationship between patients with increased risk of malnutrition and ICU LOS (p = 0.047). Routine preoperative nutrition assessment is essential to identify patients who are at higher nutritional risk, and nutrition support should be provided preoperatively.

1080 Preoperative Prealbumin Level as a Risk Factor for Pseudoarthrosis Following Lumbar Spine Surgery

INTRODUCTION: Preoperative nutritional status is essential for predicting postoperative outcomes. Studies have shown that prealbumin levels can be a prognostic indicator for surgical outcomes in spine surgery. METHODS: A retrospective cohort study of 697 patients was conducted between April 1st, 2018, to October 31st, 2022. Collected data included patient demographics, PPL, chronic steroid use, index surgery, length of surgery, postoperative hospital length of stay, 30-day return, and pseudoarthrosis (verified by a board certified neuroradiologist via radiographic imaging). PPL were first analyzed as absolute values, and then categorized as binary values. The first cut point used for binary categorization was =30 and &gt;30. We then repeated statistical analyses similarly using =25, =20, and =15 as additional cut points (all as binary values). RESULTS: Fifty-six patients had pseudoarthrosis (8%), while 641 (92%) did not. There was no statistical difference between patients who had pseudoarthrosis and patients who did not, in terms of age (62 vs. 62.9, p=0.298), BMI (29.9 vs. 29.8, p=0.441), and preoperative prealbumin level (26.6 vs 26.4, p=0.387). There was a significant difference regarding the length of surgery (337.9 mins vs. 253.8, p=0.008) and hospital length of stay (6.2 days vs. 4.2 days, p&lt;0.001) in patients with pseudoarthrosis. Finally, there was no significant difference between PPL and developing pseudoarthrosis when the data was categorized as binary values with cut points at =30 (p=0.595), =25 (p=0.987), =20 (p=0.799), and =15 (p=0.333). CONCLUSIONS: Preoperative nutritional assessment is essential in spine surgery as it can predict postoperative outcomes and recovery. In our cohort of patients, low serum prealbumin levels did not correlate with a higher rate of pseudoarthrosis following lumbar spine surgery.

Preoperative nutritional status assessment and clinical outcomes in pediatric patients undergoing gastrointestinal surgery: a prospective study

Background: The objective was to assess the association between preoperative nutritional status and postoperative outcomes in children undergoing gastrointestinal surgery. Methods: This prospective study recruited pediatric patients diagnosed with gastrointestinal surgical pathology from the pediatric surgical department in a tertiary care hospital during the period from April 2023 to October 2023. Sixty surgical cases were included in our study from both genders. An organized questionnaire was created. This questionnaire involved 3 major parts: demographic and nutritional status parameters at admission and discharge. Comparison of nutritional status pre- and postoperatively were done. Results: A total of 60 pediatric patients were enrolled. According to both STRONGKIDS score and the subjective global nutritional assessment, 58.3% of upper gastrointestinal (GI) group were at risk of malnutrition. Wasting was more common in the upper GI group 75%; versus 36.8% in the lower GI group. Underweight was more common in the hepatobiliary and upper GI groups (nearly 41.7% for each group) than in the lower GI group (26.3%). Furthermore, stunted patients had a higher incidence of complications and a prolonged hospital stay (&gt;7 days) (p=0.001 and p=0.028, respectively), while underweight lower GI patients showed a prolonged hospital stay (p=0.017). Conclusions: Nutritional assessment is an essential part of surgical management of pediatric patients. Both underweight and wasting statuses were more common among hepatobiliary and upper GI groups. A long hospital stay and postoperative complications were more common among stunted patients.

DOP03 Gaps between ECCO quality standards of care and the real world: the E-QUALITY survey on processes and outcomes

Abstract Background The European Crohn’s and Colitis Organisation (ECCO) Position Paper on Quality-of-Care (QoC) proposed essential standards on process and outcomes for units that manage patients with inflammatory bowel disease (IBD). The E-QUALITY taskforce investigated whether gaps between these standards and real-world practice exist. Methods A 74-question web survey accessible to all institutions affiliated with ECCO was developed. One delegate per institution was requested to respond. A descriptive analysis was done. Results From March to October 2023, 166 centres from 28 different countries replied to the survey (Fig.1). At diagnosis, disease extent is assessed by colonoscopy in 96% and completed by small bowel (SB) evaluation in 43%. At least 2 biopsies from each segment are obtained in 55%. SB investigation for Crohn’s disease (CD) takes place in 60%. 54% of centres provide access to endoscopy with deep sedation for the majority of patients. To assess treatment response, faecal calprotectin is used in 65%, endoscopy in 54%, cross-sectional imaging for CD in 36%. In the case of primary failure of any drug, therapeutic decisions are based on objective measures of inflammation in 98%. A scheduled monitoring protocol for asymptomatic patients is followed in 42%. Patients with prolonged use of corticosteroids are being switched to a steroid-sparing treatment in 84%, but there is no protocol to track or act upon high steroid exposure in 43% of centres. 72% centres monitor metabolic bone health. Only 51% of units screen IBD patients for colorectal cancer, but screening is done with high-definition endoscopy in 92%. Chromoendoscopy with targeted biopsies is performed in only 47% units. Patients with perianal fistula are managed by combined medical and surgical approach in 67%, and reassessment by clinical and endoscopy and/or pelvic MRI is done in 62%. Laparoscopic approach for intra-abdominal surgery is used in 76%, and preoperative nutritional assessment in 62%. Patients receive therapies to prevent post-operative recurrence based on risk factors in 70%, standard endoscopy within 6-12 months after surgery is done only in 52% of centres. Although only 8% of centres lack a defined protocol to manage acute severe ulcerative colitis flares, 13% lack a standard algorithm, and 36% do not involve the surgeon in this setting from day 1. 38% of centres have a paediatric to adult transition clinic. The main reason for not adhering to ECCO standards are difficulty of providing tests in a timely fashion in up to 83% of centres. Conclusion Our survey has revealed significant gaps between ECCO standards and real-world practice. These results will help ECCO improve initiatives to help institutions to provide standard QoC. 1) Fiorino et al. JCC 2020;14:1037-48

Retracted: Preoperative Nutritional Risk Assessment for Predicting Complications after Radical Cystectomy plus Urinary Diversion for Bladder Cancer.

[This retracts the article DOI: 10.1155/2022/2901189.].

Expert consensus on anesthesia in Enhanced Recovery after Surgery for esophageal cancer surgery

Esophageal cancer is one of the common malignant tumors of the digestive system in China. Surgical intervention is a frequently employed method for treating esophageal cancer. However, esophagectomy is a complex surgical procedure with a relatively high incidence of complications and mortality. In recent years, enhanced recovery after surgery (ERAS) as a novel medical concept, has gradually gained acceptance among healthcare professionals and been widely applied. It has also demonstrated significant efficacy in the surgical treatment of esophageal cancer. This article summarizes evidence-based medicine (EMB) in the perioperative period of ERAS for esophageal cancer treatment and formulates a clinical pathway for ERAS in esophageal cancer treatment throughout the perioperative period, aiming to provide guidance for clinical practice. Preoperatively, the following measures are advocated: preoperative education, preoperative nutrition assessment and risk assessment, individualized fasting and fluid restriction, optimal timing of surgery after neoadjuvant therapy, and the establishment of a multidisciplinary team (MDT) collaborative diagnostic and treatment model. Intraoperatively, optimization of anesthesia strategies, maintenance of optimal fluid balance, implementation of protective lung ventilation strategies, prevention of intraoperative hypothermia, and the selection of appropriate surgical techniques are essential. Postoperatively, effective pain management, thrombosis prevention, early mobilization, early removal of nasogastric tubes, drainage tubes, and urinary catheters, prevention of postoperative complications, and proactive enteral nutrition should be emphasized. It is important to note that the ERAS protocol is not static and continues to undergo improvement, with ongoing systematic training and promotion in the hope of wider adoption in more medical centers.

Prognostic Nutritional Index as a Prognostic Indicator for the Occurrence of Postoperative Complications in Patients with Esophageal Squamous Cell Carcinoma Following Neoadjuvant Immunochemotherapy.

The objective of this study was to evaluate the prognostic nutritional index (PNI) as a predictor of short-term postoperative complications in esophageal squamous cell carcinoma patients undergoing neoadjuvant immunochemotherapy. Clinical data were collected from 77 patients undergoing radical esophageal cancer surgery after neoadjuvant immunochemotherapy at Tongji Hospital from January 2022 to January 2023. The receiver operating characteristic curve (ROC) was utilized to establish the optimal cut-off point for the PNI. Subsequently, patients were stratified into low and high PNI groups according to this cut-off point, and comparisons were made between the two groups in terms of clinical data and postoperative complications. Out of the 77 patients included in the study, 31 were categorized in the low PNI group and 46 in the high PNI group, with a defined cutoff point of 47.38. Significant statistical variances were noted in the occurrence rates of general complications (P < 0.001), pulmonary infections (P < 0.001), and anastomotic fistula (P = 0.034) between the two groups. The low PNI group displayed elevated rates of these complications in comparison to the high PNI group. The research findings indicate that preoperative nutritional assessment using the PNI can effectively predict short-term postoperative complications in esophageal squamous cell carcinoma patients who have undergone neoadjuvant therapy. Furthermore, the results suggest that implementing nutritional interventions for patients with moderate-to-severe malnutrition, as indicated by preoperative PNI evaluation, may help reduce the incidence of postoperative complications.

ASO Author Reflections: Preoperative Frailty and Nutritional Assessment of Patients Undergoing Oncologic Resections.

ASO Author Reflections: Preoperative Frailty and Nutritional Assessment of Patients Undergoing Oncologic Resections.

Usefulness of the Global Leadership Initiative on malnutrition (GLIM) criteria in preoperative nutritional assessment of patients with primary lung cancer

The Global Leadership Initiative on Malnutrition (GLIM) developed a new method for evaluating malnutrition; however, no consensus has been reached regarding the use of these criteria. Therefore, this study aimed to investigate the association between nutritional status assessed using the GLIM criteria and outcomes of lung cancer after surgery. Patients with non-small cell lung cancer who underwent lung resection and bioelectrical impedance analysis to estimate muscle mass before surgery were included. Their background, pathological stage, recurrence, and prognosis were investigated. Patients were divided into two groups according to the GLIM criteria: normal nutrition and malnutrition groups. The normal and malnutrition groups comprised 110 and 88 patients, respectively. Malnutrition was significantly associated with poor overall survival after surgery (P=0.025) but not with disease-free survival. Multivariate analysis showed that malnutrition (hazard ratio [HR]:2.374, P=0.020), advanced pathological stage of lung cancer (HR: 1.919, P=0.002), and the presence of postoperative complications (HR: 2.035, P=0.047) were significantly associated with poor overall survival. Malnutrition assessed using the GLIM criteria was associated with the prognosis of patients with postoperative non-small cell lung cancer. Preoperative assessment using the GLIM criteria would allow for effective nutritional and rehabilitative interventions to improve prognosis.

Efficacy of early enteral nutrition to enhance recovery after major abdominal surgeries in cancer patients

Background Malnutrition is a significant prognostic factor in surgical cancer patients, especially when the malignancy is localized to the gastrointestinal tract. Aim The goal of this study was to evaluate the impact of early enteral feeding on nutritional status and clinical outcomes in patients who had undergone abdominal surgery for cancer. Patients and methods Forty patients, ranging in age from 20 to 60 years, admitted to the postoperative surgical ICU underwent preoperative nutritional assessment and were followed daily from the morning of postoperative day 1 in the ICU until the evening of day 4 for the possibility of starting enteral nutrition safely. Participants were differentiated into early and late groups according to the time of establishment of enteral feeding. To compare early and late groups of the studied patients, clinical and laboratory nutritional markers and clinical outcomes were traced and statistically analyzed. Results Both groups had 12 (60%) males and eight (40%) females, with a mean±SD age of 43.6±8.15 years in the early group and 41.75±6.65 years in the late group. The early group had a substantially higher mean percentage BMI gain (2.50±0.35) than the late group (0.89±0.20). The early group had statistically higher serum prealbumin levels than the late group after 4 days. Early enteral feeding increased the prealbumin percentage by 25.37±5.93 compared with 15.93±1.98 in the late group. Early enteral feeding increased the total cholesterol levels. Early enteral feeding had a mean cholesterol percentage change of 32.04±6.74% compared with 17.23±4.23% in the late group. Early enteral nutrition patients spent 3.2±0.77 days in the ICU compared with 5.2±0.77 days for the late group. Patients in the early group had a considerably shorter hospital stay (6.8±1.51 days) than those in the late group (10.2±1.51 days). The incidence of superficial surgical infection was 40% in the late group compared with none in the early group, and the two groups differed statistically significantly. Conclusion The nutritional status of patients with cancer who undergo major abdominal surgery greatly benefits from beginning enteral feeding early. The incidence of surgical complications decreased, and hospital and ICU stays were shortened when enteral feeding was started early.

FTP4.8 A survey on enhanced recovery after surgery (ERAS) in Pakistan

Abstract Introduction ERAS protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the stress response following surgery. Despite a significant body of evidence indicating that ERAS protocols lead to improved outcomes, implementation has been slow, and is not yet universal. The aim of this study was to evaluate current implementation of enhanced recovery protocols among Pakistani surgeons. Methods A survey questionnaire consisting of 23 items was created to assess current trends in perioperative management of patients undergoing major surgery, and to ascertain the extent to which ERAS is understood and implemented. Results The survey was answered by 100 individuals. 32 % of participants were familiar with ERAS protocols. All participants gave pre-operative counselling. 26% performed preoperative nutritional assessment with provision of pre-operative nutritional support in 24 % cases. Anaemia was managed in 84 % cases and smoking cessation done in 70 %. Patients were kept nil per oral for &amp;gt; 6 hrs in about 80 % cases. Antibiotic prophylaxis given in 94 % cases. Preoperative loading with carbohydrate drinks is carried out in only 2% of cases with 90 % being unfamiliar with the term; nasogastric tube done (58 %), transurethral drainage (42%). opioid analgesia use 54 % and multi modal analgesia used in only 32 %. Prophylaxis for postoperative nausea and vomiting (34%), VTE prophylaxis 26 %. Early mobilization (84%) and early feeding in only 32 % was performed. Conclusion An ERAS program requires a dedicated multidisciplinary team willing to abandon out-dated paradigms and embrace new ideas.