Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study

Abstract

Background Although postoperative early oral feeding in the enhanced recovery after surgery (ERAS) program for pancreaticoduodenectomy (PD) is deemed safe, the assessment of oral intakes has been insufficient. This study aimed to investigate postoperative oral intakes and the effectiveness of an ERAS program incorporating early enteral nutrition (EN). Methods In total, 203 patients with PD were enrolled retrospectively. The first group (group E1; n = 61) comprised 11 ERAS care elements, whereas the second group (group E2; n = 106) comprised 19 elements. The control group (group C; n = 36) was managed using traditional care before ERAS was implemented. Postoperative energy and protein requirements were estimated at 25–30 kcal per kilogram of ideal body weight and 1.2–1.5 g per kilogram of ideal body weight, respectively, and were investigated along with the length of hospital stay (LOS). Results The oral energy and protein intakes from the diets in the ERAS groups at postoperative day 7 significantly increased compared with those in group C. Intakes in groups E1 and E2 were not significantly different and provided <30% of the requirements. However, the total intakes, which were compensated by EN, were maintained at >80% of the requirements. LOS was significantly shorter in groups E1 (31 days) and E2 (19 days) than in group C (52 days). Conclusions Postoperative early oral energy and protein intakes of this modified ERAS program failed to meet the dietary requirements. However, early EN compensated for the shortages and contributed to the reduction of LOS.

Nutrition Care Process of Surgical Patients in the Context of Enhanced Recovery After Surgery

“…In addition, the European Society of Parenteral and Enteral Nutrition recommends that immunonutrition formulas should commence before surgery and continue for 5 to 7 days postoperatively. [52][53][54][55][56][57] They should not be used in patients undergoing elective surgery because evidence…”

“… 49–51 Other groups, such as the American Society of Parenteral and Enteral Nutrition and the European Society of Parenteral and Enteral Nutrition, recommend the use of immunonutrition formulas in malnourished patients who undergo major neck or abdominal cancer surgery. In addition, the European Society of Parenteral and Enteral Nutrition recommends that immunonutrition formulas should commence before surgery and continue for 5 to 7 days postoperatively 52–57 . They should not be used in patients undergoing elective surgery because evidence is lacking on whether they are effective in well-nourished surgical patients.…”