Impact of Early Postoperative Oral Nutritional Supplement Utilization on Clinical Outcomes in Colorectal Surgery

Abstract

Background: Small randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking.Methods: Using a nationwide administrative-financial database (Premier Healthcare Database), we examined the association between early ONS use and postoperative clinical outcomes in patients undergoing elective open or laparoscopic CRS between 2008–2014. Early ONS was defined as the presence of charges for ONS before postoperative day (POD) 3. The primary outcome was composite infectious complications. Key secondary efficacy (intensive care unit (ICU) admission and gastrointestinal complications) and falsification (blood transfusion and myocardial infarction) outcomes were also examined. Propensity score matching was used to assemble patient groups that were comparable at baseline and differences in outcomes were examined.Results: Overall, patients receiving early ONS were older with greater comorbidities, and more likely to be Medicare beneficiaries with malnutrition. In a well-matched sample of early-ONS recipients (n=267) versus non-recipients (n= 534), infectious complications were significantly lower in early-ONS recipients (6.7% vs. 11.8%, P<0.03). Early-ONS use was also associated with significantly reduced rates of pneumonia (P<0.04), ICU admissions (P<0.04), and gastrointestinal complications (P<0.05). There were no significant differences in falsification outcomes. Conclusions: Although early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity-score matched study using real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients.

Impact of Preoperative Total Proteins and Glycated Hemoglobin on Recurrences after Early Colorectal Cancer

“…Curiously, we established a cut-off point at a protein level within the normal range. However, it has been widely demonstrated that preoperative normo-nourished patients can develop undernutrition during the postoperative course, secondary to the inflammatory response to the surgical damage and a delay in the reintroduction of oral nutrition [ 18 ]. Therefore, the actual recommendations of perioperative care within Enhanced Recovery After Surgery protocols consider an eventual indication of preoperative oral supplementation in normo-nourished patients undergoing colorectal surgery, in order to reduce postoperative complications and a certain degree of immunologic deficiency associated with the postoperative decrease of serum proteins [ 19 ].…”

Assessment of Malnutrition in Emergency Laparotomy Patients. A QIP Highlights Simple Measures To Improve Early Recognition and Optimisation of High-Risk Patients.

“…6 Therefore, early identi cation and management of the nutritional concerns can improve the surgical outcomes and ultimately reduce the length of stay. 7,8 Despite all the national efforts across UK hospitals to ensure routine nutritional screening is performed on all admissions, National Audit of Small Bowel Obstruction (NASBO) identi ed that the level of nutritional support remains low. 9 This raises the question of whether malnutrition still appears to be overlooked and not considered as a su cient medical priority.…”