ACERTO guidelines of perioperative nutritional interventions in elective general surgery

Abstract

Objective: to present recommendations based on the ACERTO Project (Acceleration of Total Post-Operative Recovery) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures. Methods: review of relevant literature from 2006 to 2016, based on a search conducted in the main databases, with the purpose of answering guiding questions previously formulated by specialists, within each theme of this guideline. We preferably used randomized controlled trials, systematic reviews and meta-analyzes but also selected some cohort studies. We contextualized each recommendation-guiding question to determine the quality of the evidence and the strength of this recommendation (GRADE). This material was sent to authors using an open online questionnaire. After receiving the answers, we formalized the consensus for each recommendation of this guideline. Results: the level of evidence and the degree of recommendation for each item is presented in text form, followed by a summary of the evidence found. Conclusion: this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons, the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery. The prescription of these recommendations can accelerate the postoperative recovery of patients submitted to elective general surgery, with decrease in morbidity, length of stay and rehospitalization, and consequently, of costs.

Enhanced Recovery (Eras) After Liver Surgery:comparative Study in a Brazilian Terciary Center

“…In our study, a significant number of patients completed the fasting protocol, with light meals intake until 6 h before surgery, and carbohydrate loading with maltodextrin 2 h before operation. These measures not only give comfort and reduce anxiety in preoperative hours, but are also related to a reduction in catabolism and insulin resistance in some papers 2 , 3 , 14 . Of note, we did not verified and increase in perioperative complications (like aspiration during anesthesia or postoperative pneumonia) following these recommendations.…”

“…Despite significant improvements in perioperative management and surgical technique, which led to a reduction in postoperative mortality to less than 5%, major hepatectomies still have a morbidity rate up to 30% in some reports 9 - 11 . This way, the implementation of evidenced-based recommendations in order to optimize perioperative recovery can greatly benefit patients and health providers 3 .…”

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

“…Most data concerning cardiac surgery were extrapolated from studies on patients undergoing abdominal surgery. Starting from Kehlet’s studies in 2002, several fast-track surgery protocols have been proposed like the ACERTO Project (Acceleration of Total Postoperative Recovery) or ERAS [ 64 , 65 , 66 ]. Studies confirm that compliance with only a few elements of those protocols results in fewer benefits for outcome improvement.…”

Factors Related to the Reduction of the Risk of Complications in Colorectal Surgery Within Perioperative Care Recommended by the Acerto Protocol

“…The ACERTO protocol is constituted of various prescriptions including poutines from pre- to postoperative period of surgical patients. In summary the routines are: 1) preoperative fasting time abbreviation (6-8 h for solids and 2 h for clear fluids) - ingestion of a beverage containing 12.5% maltodextrin the night before and again 2 h before anesthetic induction; 2) early postoperative feeding with oral liquid diet in the same day or next day of the procedure; 3) intravenous fluids using Ringer-Lactate solution only until the first postoperative day at a volume of 30 ml/kg/day; 4) no mechanical bowel preparation as routine; 5) nutritional status assessment followed by nutritional therapy for 7-14 days before the procedure for nutritional risk patients; 6) prevention of nauseas and vomiting; 7) antibiotic prophylaxis; 8) deep venous thrombosis prophylaxis; 9) restrict use of drains and nasogastric tubes; 10) early mobilization 2 , 11 . As shown below only some of these routines were studied as risk factors.…”