scholarly journals The nutritional management of surgical patients: enhanced recovery after surgery

2003 ◽  
Vol 62 (4) ◽  
pp. 807-811 ◽  
Author(s):  
Kenneth C. H. Fearon ◽  
Rachel Luff
Keyword(s):  
Enhanced Recovery ◽  
Elective Surgery ◽  
Rectal Surgery ◽  
Oral Feeding ◽  
Morbidity And Mortality ◽  
Surgical Trauma ◽  
Early Recovery ◽  
Oral Nutrition ◽  
Operative Morbidity ◽  
Early Oral Feeding

Malnutrition has long been recognised as a risk factor for post-operative morbidity and mortality. Traditional metabolic and nutritional care of patients undergoing major elective surgery has emphasised pre-operative fasting and re-introduction of oral nutrition 3–5 d after surgery. Attempts to attenuate the consequent nutritional deficit and to influence post-operative morbidity and mortality have included parenteral, enteral and oral sip feeding. Recent studies have emphasised that an enhanced rate of recovery can be achieved by a multi-modal approach focused on modulating the metabolic status of the patient before (e.g. carbohydrate and fluid loading), during (e.g. epidural anaesthesia) and after (e.g. early oral feeding) surgery. Using such an approach preliminary results on patients undergoing elective colo-rectal surgery indicate a significant reduction in hospital stay (traditional care, n 48, median stay 10 d v. enhanced recovery programme, n 33, median stay 7d; P<0·01) can be achieved. Such findings emphasise the potential role of multi-modal care programmes in the promotion of early recovery from major surgical trauma.

scholarly journals Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1758 ◽  
Author(s):  
Fabian Grass ◽  
Martin Hübner ◽  
Jenna Lovely ◽  
Jacopo Crippa ◽  
Kellie Mathis ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Outcome Data ◽  
Normal Diet ◽  
Oral Feeding ◽  
Prolonged Length ◽  
Early Oral Feeding ◽  
American Society ◽  
Independent Decision ◽  
Recovery Pathways

Early re-alimentation is advocated by enhanced recovery pathways (ERP). This study aimed to assess compliance to ERP-set early re-alimentation policy and to compare outcomes of early fed patients and patients in whom early feeding was withhold due to the independent decision making of the surgeon. For this purpose, demographic, surgical and outcome data of all consecutive elective colorectal surgical procedures (2011–2016) were retrieved from a prospectively maintained institutional ERP database. The primary endpoint was postoperative ileus (POI). Surgical 30-day outcome and length of stay were compared between patients undergoing the pathway-intended early re-alimentation pattern and patients in whom early re-alimentation was not compliant. Out of the 7103 patients included, 1241 (17.4%) were not compliant with ERP re-alimentation. Patients with delayed re-alimentation presented with more postoperative complications (37 vs. 21%, p < 0.001) and a prolonged length of hospital stay (8 ± 7 vs. 5 ± 4 days, p < 0.001). While male gender (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.04–1.32), fluid overload (OR 1.38; 95% CI 1.16–1.65) and high American Society of Anaesthesiologists (ASA) score (OR 1.51; 95% CI 1.27–1.8) were independent risk factors for POI, laparoscopy (OR 0.51; 95% CI 0.38–0.68) and ERP compliant diet (OR 0.46; 95% CI 0.36–0.6) were both protective. Hence, this study provides further evidence of the beneficial effect of early oral feeding after colorectal surgery.

scholarly journals Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 264 ◽  
Author(s):  
Ho Chiou Yi ◽  
Zuriati Ibrahim ◽  
Zalina Abu Zaid ◽  
Zulfitri ‘Azuan Mat Daud ◽  
Nor Baizura Md. Yusop ◽  
...  
Keyword(s):  
Whey Protein ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Cancer ◽  
Intervention Group ◽  
Oral Feeding ◽  
Control Group ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
The Impact

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag?

2019 ◽  
Vol 22 (1) ◽  
pp. 95-101 ◽  
Author(s):  
K. Slim ◽  
T. Reymond ◽  
J. Joris ◽  
S. Paul ◽  
B. Pereira ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Oral Feeding ◽  
Early Oral Feeding ◽  
Red Flag

Safety and efficacy of early oral feeding for enhanced recovery following gastrectomy for gastric cancer: A systematic review

2019 ◽  
Vol 28 ◽  
pp. 88-95 ◽  
Author(s):  
Thaís Tweed ◽  
Yara van Eijden ◽  
Juul Tegels ◽  
Hylke Brenkman ◽  
Jelle Ruurda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Enhanced Recovery ◽  
Oral Feeding ◽  
Safety And Efficacy ◽  
Early Oral Feeding

scholarly journals EARLY ORAL FEEDING POST-UPPER GASTROINTESTINAL TRACT RESECTION AND PRIMARY ANASTOMOSIS IN ONCOLOGY

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Lilian Pinheiro LOPES ◽  
Taysa Machado MENEZES ◽  
Diogo Oliveira TOLEDO ◽  
Antônio Talvane Torres DE-OLIVEIRA ◽  
Adhemar LONGATTO-FILHO ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Total Gastrectomy ◽  
Primary Anastomosis ◽  
Gastrointestinal Surgery ◽  
Oral Intake ◽  
Wound Dehiscence ◽  
Oral Feeding ◽  
Oral Nutrition ◽  
Early Oral Feeding ◽  
Upper Gastrointestinal

ABSTRACT Background: The practice of starving patients in the immediate period after upper gastrointestinal surgery is widespread. Early oral intake has been shown to be feasible and may result in faster recovery and decrease length of hospital. Aim: To evaluate the feasibility and safety of oral nutrition on postoperative early feeding after upper gastrointestinal surgeries. Methods: Observational cohort design study with convenience retrospective data in both genders, over 18 years, undergoing to total gastrectomy and/or elective esophagectomy. They have received oral or enteral nutrition in less than 48 h after surgery, and among those who started with enteral nutrition, the oral feeding up to seven days. Results: The study was performed in 161 patients, 24 (14.9%) submitted to esophagectomy, 132 (82%) to total gastrectomy and five (3.1%) to esophagogastrectomy. Was observed good dietary acceptance and low percentage (29%) of gastrointestinal intolerances, more pronounced among those with enteral diet. Most of the patients did not present postoperative complications, 11 (6.8%) were reopened, five (3.1%) had fistulas, three (1.9%) wound dehiscence, three (1.9%) fistula more wound dehiscence and six (3.7%) other non-infectious complications. Conclusion: Early oral diet is safe and viable for patients undergoing upper gastrointestinal surgery.

scholarly journals ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Uirá Fernandes TEIXEIRA ◽  
Marcos Bertozzi GOLDONI ◽  
Fábio Luiz WAECHTER ◽  
José Artur SAMPAIO ◽  
Florentino Fernandes MENDES ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Surgical Stress ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Oral Feeding ◽  
Control Group ◽  
Colonic Surgery ◽  
Early Oral Feeding ◽  
Tertiary Center ◽  
Eras Protocol

ABSTRACT Background: After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. Aim: To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Results: There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.

scholarly journals Short-term outcome after cystectomy: comparison of early oral feeding in an enhanced recovery protocol and feeding using Bengmark nasojejunal tube

2017 ◽  
Vol 36 (2) ◽  
pp. 221-229 ◽  
Author(s):  
C. S. Voskuilen ◽  
E. E. Fransen van de Putte ◽  
J. Bloos-van der Hulst ◽  
E. van Werkhoven ◽  
W. M. de Blok ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Oral Feeding ◽  
Short Term ◽  
Term Outcome ◽  
Early Oral Feeding ◽  
Short Term Outcome ◽  
Nasojejunal Tube ◽  
Enhanced Recovery Protocol

P-OGC05 The introduction of an Upper Gastrointestinal (UGI) specific menu can reduce the need for routine jejunostomy (JEJ) placement following UGI Cancer resection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Vida Dossou
Keyword(s):  
Patient Satisfaction ◽  
Staff Training ◽  
Nutritional Support ◽  
Enhanced Recovery ◽  
Oral Intake ◽  
Oral Feeding ◽  
Ward Staff ◽  
Cancer Resection ◽  
Early Oral Feeding ◽  
Satisfaction Surveys

Abstract Background Despite the fact that early oral feeding (EOF) after the surgical resection of oesophageal and gastric tumours is safe, and is associated with favourable early in-hospital outcomes, sooner return to physiological GI function and hospital discharge, there can still be some reluctance in establishing EOF. Concerns remain around risk of anastomotic leak, pneumonia, Naso-gastric tube (NGT) reinsertion, re-operation, readmissions and mortality. However, when utilising EOF, a reduction in length of stay, earlier removal of NGT and earlier initiation of soft diet can be observed. JEJ placement is beneficial however  complications can arise and the optimal nutritional pathway remains debatable.  Methods Patient satisfaction surveys were conducted amongst UGI Cancer patients following Cancer resection and analysed pre and post UGI menu development and staff training. Expert UGI Patient volunteers assisted in the UGI menu development through food tastings producing a new menu in collaboration with the catering department. The new menu was launched and an UGI snack box provided to the UGI Enhanced Recovery Unit (ERAS).  Oral intake of Diet and Oral Nutritional Support was analysed for calorie and protein content post menu change, ward staff training and specialist UGI dietetic counselling. This was then compared with calculated minimum estimated nutritional requirements.  Results Of the ten patients audited pre discharge: Remaining 1 patient achieved 51% of protein requirements, below the aim of 60%. No patient audited required supplementary Enteral feeding via JEJ or Naso-jejunal tube Patient satisfaction surveys were completed prior to catering staff training and menu revision, after the new menu was implemented. The results show a significant improvement in patient satisfaction following UGI menu implementation. Conclusions Specialist UGI RD support, UGI specific menu and Oral Nutritional Support can reduce the need for routine JEJ placement in favour of on an individual patient basis.  Collaborative working between UGI Dietitians, Ward staff, Catering staff and Expert patients is required for UGI specific menu development to be effectual.  This audit is limited to small numbers due to adapted operational procedures during the pandemic. This audit will be repeated on a larger scale to yield more meaningful data.   Future audit will capture data on how many UGI patients went on to require enteral nutritional support with three months of discharge.

scholarly journals A study of early versus conventional oral feeding in women undergoing caesarean section

2020 ◽  
Vol 9 (12) ◽  
pp. 4839
Author(s):  
Devina Nagraj ◽  
Ching Ling Yi ◽  
Asha R. Dalal
Keyword(s):  
Caesarean Section ◽  
Financial Burden ◽  
Oral Feeding ◽  
Early Feeding ◽  
Early Recovery ◽  
Gastrointestinal Complications ◽  
Early Oral Feeding ◽  
Feeding Group ◽  
Group A ◽  
The Government

Background: Traditionally women undergoing lower segment caesarean section (LSCS) had oral food withheld for12-24 hours to prevent gastrointestinal complications. However, it was observed in many studies, that early oral feeding to patients post LSCS improves recovery and decreases chances of post-operative complications.Methods: This was a randomized interventional study conducted in a public hospital. Uncomplicated patients who underwent LSCS under regional anesthesia were selected. Group A and B with 100 participants each were made. One group (A) was given early orals (6 hours) and other group (B) was given orals after 12 hours.Results: The early feeding group had earlier return of bowel movements and earlier passage of flatus (8 and 13 hours) as opposed to delayed feeding group (10 and 18 hours). 13% patients in the early feeding group had complications as opposed to 43% patients in the delayed feeding group. The most common complication was abdominal distension which was seen in 5 and 10 patients of the early and delayed feeding group respectively.Conclusions: Early oral feeding after LSCS can lead to early recovery, better mother and child health, better utilization of the hospital resources and decreased financial burden on the family as well as the government in the long run.

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