Effect of Immediate Postoperative Nutritional Support on Length of Hospitalization

Abstract

This study is a retrospective review of the effect of nutritional support on duration of hospitalization in patients undergoing radical cystectomy. Thirty-five patients were randomly assigned to receive either 5% dextrose (D5W) solution plus electrolytes or total parenteral nutrition (TPN) following operation. The assigned nutritional regimen was continued for 1 week after operation until oral intake resumed. If the patients receiving D5W remained incapable of oral intake after 1 week, TPN was instituted. The group receiving immediate postoperative TPN had a median duration of hospitalization of 17 days, while the median duration for the group receiving 5% dextrose solution was 24 days. All other patient characteristics, such as age, sex, stage/grade of tumor, and extent of preoperative radiotherapy, were similar in the two groups. These results demonstrate that immediate postoperative institution of nutritional support reduced hospitalization time following radical cystectomy. This indicates that the routine use of 5% dextrose as postoperative nutrition should be reevaluated.

A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients

“…Studies of nutritional repletion in malnourished patients with fractured neck of femur,11 12 patients in care on an elderly ward,13 and studies of preoperative14 and postoperative nutritional support15 16 have demonstrated reduced morbidity and/or reduced length of hospital stay. Information on repletion after discharge is limited, particularly in the mildly depleted patient.…”

Optimal Nutrition Should Improve the Outcome and Costs of Radical Cystectomy

“…Radical cystectomy results in catabolic metabolism and tissue breakdown leading to a prolonged period of negative nitrogen balance [8] . TPN can reliably deliver full nutritional requirements, regardless of bowel recovery, and studies comparing TPN to unfed subjects demonstrated that TPN can successfully reverse negative nitrogen balance within 4 days of cystectomy, thereby abolishing tissue loss [8] and reducing hospital stay [2] . However, these early trials were of doubtful quality and a recent meta-analysis of randomised controlled trials involving 2,211 surgical patients demonstrated no overall reduction in morbidity or mortality for TPN compared to standard care [3] .…”

“…Nutritional support is an important area of post-operative care which has been demonstrated to improve recovery from cystectomy [2] . However, post-operative nutrition is a controversial subject and other studies have failed to show benefi t from nutrition in surgical patients [3] .…”

Parenteral nutrition in the critically-ill patient: more harm than good?

“…There are twenty-six randomized trials involving 2211 patients that compare the use of PN with standard care (usual oral diet plus intravenous fluids) in patients undergoing surgery (Abel et al 1976;Holter & Fischer, 1977;Freund et al 1979;Lim et al 1981;Thompson et al 1981;Yamada et al 1983;Askanzi et al 1986;Bower et al 1986;Bellatone et al 1988;Cerra et al 1988;Meguid et al 1988;Smith & Hartemink, 1988;Woolfson & Smith, 1989;Gys et al 1990;Hamaoui et al 1990;Schroeder et al 1991;Von Meyenfeldt et al 1992;Brennan et al 1994;Fan et al 1994;Hadfield et al 1995;Jimenez et al 1995;Baigrie et al 1996), patients with pancreatitis (Sax et al 1987), patients in an intensive care unit (Chiarelli et al 1996) and patients with severe burns (Herndon et al 1989). The details of individual studies, including the methodological quality score of each study, are described in Table 2.…”