Perioperative peripheral parenteral nutrition to support major gastrointestinal surgery: Expert opinion on treating the right patients at the right time

Abstract

Background & aims: Patients undergoing major gastrointestinal surgery may be in particular need of nutritional therapy due to potential pre-existing disease-related malnutrition and the impact of surgical procedures. Peripheral parenteral nutrition (PPN), delivered via a peripheral catheter, is aligned with the Enhanced Recovery After Surgery (ERAS) concept of minimally invasive interventions where possible. However, uncertainties regarding perioperative PPN for patients undergoing major gastrointestinal surgery arise, in part, due to lack of clinical guidelines. This paper aims to provide practical guidance on perioperative PPN, within the framework of ERAS. Methods: A panel of surgeons and nurses convened to identify knowledge gaps and share their best practice experience regarding PPN provision for patients undergoing major gastrointestinal surgery. Clinical needs were identified and addressed based on the panel's experience and a narrative review. Results: Key topics addressed include how PPN can support ERAS nutritional recommendations, identifying gastrointestinal surgery patient subgroups who are likely to benefit from PPN, perioperative timepoints when PPN may be required, and optimizing the delivery of PPN. An algorithm to support the identification and management of patients' perioperative nutritional needs was developed. Conclusions: This paper aims to assist healthcare providers by addressing best practice questions related to the use of PPN during the critical perioperative period within the ERAS concept. This may facilitate timely nutritional intervention to help improve postoperative clinical outcomes and quality of life for patients undergoing major gastrointestinal surgery.

Nutrition practices with a focus on parenteral nutrition in the context of enhanced recovery programs: An exploratory survey of gastrointestinal surgeons

“…However, the quality of nutritional care was rated as mediumelow by 67.3% of respondents, due in part to infrequent presence of a NST and late/absent MNT [22]. Multidisciplinary care, combining the specialist skills of different HCPs, is best placed to optimize perioperative nutrition support [18,23]. The findings from this study indicate there is a lack of multidisciplinary NSTs across several countries in Europe, particularly in Poland.…”

“…When oral and EN support is insufficient, PPN e which does not require insertion of a central line e facilitates timely MNT in patients who are catabolic or at nutritional/metabolic risk, thereby bridging the nutritional gap [18]. This aligns with the ERAS concept of using minimally invasive approaches where possible [18]. Over two-thirds of surgeons (71%) agreed PPN provides less invasive MNT versus centrally delivered PN and benefits selected patients when oral/EN is insufficient.…”

“…When oral and EN support is insufficient, PPN e which does not require insertion of a central line e facilitates timely MNT in patients who are catabolic or at nutritional/metabolic risk, thereby bridging the nutritional gap [18]. This aligns with the ERAS concept of using minimally invasive approaches where possible [18].…”

“…A key focus of ERAS recommendations, which advocate for minimally invasive procedures, is to minimize the adverse metabolic and catabolic consequences of surgery [11e17]. Despite PPN offering a less invasive approach than centrally delivered PN to support ERAS nutritional strategies when oral and/or EN are insufficient or not feasible, ERAS guidance on the use of PN, and particularly on PPN in the perioperative period including prehabilitation, are lacking [18,19].…”

Trajectories of Health-Related Quality of Life, Health Literacy, and Self-Efficacy in Curatively-Treated Patients with Esophageal Cancer: A Longitudinal Single-Center Study in Italy

“…A recent meta-analysis indicated that the levels of HRQoL achieved by patients with esophageal cancer within three months from surgery tend to be stable also in long-term assessments ( 10 , 15 , 17 , 33 ). This evidence suggests that understanding which elements in the early assessment of patient needs might influence HRQoL over the first three months after surgery is particularly important to achieve long-term and stable positive outcomes regarding patient experiences and HRQoL ( 15 , 34 ).…”