Effect of long-lasting nutritional prehabilitation on postoperative outcome in elective surgery for IBD

Fiorindi, Camilla; Cuffaro, Francesca; Piemonte, Guya; Cricchio, Marta; Addasi, Rami; Dragoni, Gabriele; Scaringi, Stefano; Nannoni, Anita; Ficari, Ferdinando; Giudici, Francesco

doi:10.1016/j.clnu.2020.06.020

Cited by 34 publications

(32 citation statements)

References 23 publications

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“…In the last decade, the development of minimal invasive surgery has been dramatically accelerated due to the introduction of single-incision laparoscopic (SILS) and robotic surgery, which significantly improved the quality of surgery regarding perioperative recovery of patients, enhanced body image and cosmesis [42][43][44]. Furthermore, the implementation of structured perioperative patient care programs such as prehabilitation and "Fast Track Surgery"/"ERAS" (enhanced recovery after surgery) results in earlier recovery and decreased morbidity [45][46][47]. These perioperative and surgical developments and advancements help to partially offset the negative impact of patient's comorbidities and complicated disease phenotype on postoperative outcomes including disease-, surgical-and nonsurgical-related complications.…”

Section: Early Surgical Therapy In Crohn's Disease Is Characterized By Low Morbidity and Mortalitymentioning

confidence: 99%

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

et al. 2021

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Crohn’s disease (CD) represents a heterogeneous and complex disease with no curative therapeutic option available to date. Current therapy is mainly antibody-based focusing on the immune system while other treatment alternatives such as surgery are considered to be “last options”. However, medical therapy for CD results in mild to severe side effects in a relevant amount of patients and some patients do not respond to the medication. Following that, quality of life is often significantly reduced in this patient cohort, thus, therapeutic alternatives are urgently needed. Updated evidence has revealed that surgery such as ileocecal resection (ICR) might be a potential therapeutic option in case of localized terminal ileitis since resection at early time points improves quality of life and significantly reduces the postoperative need for immunosuppressive medication with low rates of morbidity. In addition, new surgical approaches such as Kono-S anastomosis or inclusion of the mesentery result in significantly reduced rates of disease recurrence and reoperation. Based on the new evidence, the goal of this review is to provide an update on the role of surgery as a reasonable alternative to medical therapy in the interdisciplinary treatment of patients with CD.

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Section: Early Surgical Therapy In Crohn's Disease Is Characterized By Low Morbidity and Mortalitymentioning

confidence: 99%

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

et al. 2021

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“…Indeed, the impact of preoperative identification of nutrition risk and preoperative nutrition intervention is known to improve surgical outcomes. A recent prospective study by Fiorindi et al investigated the impact of early oral nutrition on postoperative recovery and body composition in surgical Crohn's disease (CD) and ulcerative colitis (UC) patients 44 . A total of 61 patients (45 CD and 16 UC) were included, of which 25% were at high nutrition risk.…”

Section: Discussionmentioning

confidence: 99%

Validation of the perioperative nutrition screen for prediction of postoperative outcomes

Williams

Aronson

Murray

et al. 2022

J Parenter Enteral Nutr

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Background Preoperative nutrition risk is often underrecognized and undertreated. The perioperative nutrition screen (PONS) was recently introduced as an efficient tool to rapidly screen for preoperative nutrition risk. The relationship between identification of “nutrition risk” via PONS and adverse postoperative outcomes remains undescribed. Methods Preoperative nutrition risk was assessed via PONS from 01/01/2019 to 09/30/2020. Key clinical outcomes were compared with individual and composite PONS components. Results A total of 3151 patients with PONS evaluations were analyzed. Multivariate regression adjusted for key covariates demonstrated positive responses for specific PONS questions was associated with adverse clinical outcomes as follows. (1) Unplanned weight loss (>10% in 6‐months preoperatively) associated with a 22.4% increased length of stay (LOS) (P < 0.0001) and increased 30‐day readmission rate (odds ratio [OR], 2.44, 95% CI, 1.73–3.44, P < 0.001). (2) History of <50% of previous oral intake in past week associated with a 25% increased LOS (P < 0.001). (3) Preoperative serum albumin level <3.0 g/L associated with a 29.9% increased LOS (P < 0.001) and increased 30‐day readmission rate (OR, 2.66, 95% CI, 1.63–4.35, P < 0.001). (4) Low body mass index was not associated with increased LOS by adjusted analysis although was predictive by univariate analysis. Conclusions The PONS and its individual components appear to predict risk of adverse postoperative outcomes, even independent of a validated malnutrition diagnosis. Further studies are needed to assess the impact of specific preoperative nutrition interventions on adverse outcomes predicted by PONS when delivered to patients identified via PONS screen.

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“…Nutritional and electrolyte status, as well as presence of existing sepsis, must be determined, as these elements may be improved or corrected preoperatively to make surgery less difficult and lessen morbidity of recovery. [10][11][12] For patients who have been treated with radiation therapy, the surgeon should investigate specifics, location, and timing of treatment. 4,5 Another important component of preoperative assessment of patients with a hostile abdomen is the establishment of surgical goals.…”

Section: Preoperative Preparation Initial Evaluationmentioning

confidence: 99%

Management of the Hostile Abdomen

Lundy

Ashburn

2022

Clin Colon Rectal Surg

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Caring for a patient with a hostile abdomen is one of the most challenging clinical situations one can encounter. It requires specialized technical skill coupled with bold but thoughtful decision-making to achieve good outcomes. An approach to the patient with a complex, hostile abdomen must be individualized to account for the patient's personal details. However, implementing an experienced-based algorithm to help make the difficult decisions required in this setting can be helpful, as evidence-based studies are few. The purpose of this review is to provide a structured, evidence, and experienced-based approach to the challenges that the surgeon encounters when faced with a patient with a hostile abdomen, and to discuss perioperative and intraoperative surgical strategies that can lead to most successful outcomes.

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Effect of long-lasting nutritional prehabilitation on postoperative outcome in elective surgery for IBD

Cited by 34 publications

References 23 publications

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

The Revival of Surgery in Crohn’s Disease—Early Intestinal Resection as a Reasonable Alternative in Localized Ileitis

Validation of the perioperative nutrition screen for prediction of postoperative outcomes

Management of the Hostile Abdomen

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