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

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> 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. <jats:bold>Methods:</jats:bold> 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.<jats:bold>Results:</jats:bold> 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%, <jats:italic>P</jats:italic>&lt;0.03). Early-ONS use was also associated with significantly reduced rates of pneumonia (<jats:italic>P</jats:italic>&lt;0.04), ICU admissions (<jats:italic>P</jats:italic>&lt;0.04), and gastrointestinal complications (<jats:italic>P</jats:italic>&lt;0.05). There were no significant differences in falsification outcomes. <jats:bold>Conclusions:</jats:bold> 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.</jats:p>

Meta-analysis of omega-3 polyunsaturated fatty acids on immune functions and nutritional status of patients with colorectal cancer

“…Furthermore, surgery-induced immunosuppression and immune dysfunction significantly trigger postoperative complications. Numerous studies have attributed malnutrition and immune dysfunction to postoperative complications, such as surgical site infection, anastomotic leak, intra-abdominal abscess, ureteral injury, bleeding, enteric fistula, and postoperative bowel obstruction (11)(12)(13)(14). Thus, these complications significantly increase the hospital stay and associated medical costs as well as significantly decline the patient's quality of life and increase cancer recurrence (15,16).…”

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.…”