Perioperative nutrition in the light of guidelines
(and in the shadow of practice)

Česká verzia

Authors: I.satinský ^1,2
Authors place of work: Mezioborová jednotka intenzivní péče − pro chirurgické obory, Nemocnice Havířov ¹; Ústav ošetřovatelství, Fakulta veřejných politik, Slezská univerzita v Opavě ²
Published in the journal: Rozhl. Chir., 2021, roč. 100, č. 2, s. 49-59.
Category: Review

Summary

Nutritional support is one of the fundamental conditions of a successful outcome in malnourished or critically ill patients. Malnutrition is an important negative factor with impacts on postoperative morbidity and lethality in surgical patients. It is often observed in particularly in oncosurgical patients, in the elderly and in patients with chronic intestinal disease. The issue of malnutrition should be medically managed from the very moment the ill person becomes a patient. The effort of correcting malnutrition should extend over the entire perioperative period – from the beginning of the diagnostic procedure, during the hospital stay with surgery as applicable with postoperative nutrition therapy, to nutritional status monitoring after discharge and in the course of subsequent follow-up in the outpatient setting. Recent European and Czech guidelines adopted by the Czech Surgical Society and by the other societies exist for this complex issue. However, the use of these guidelines often encounters barriers in practice, and their implementation rate is thus rather low. Nutrition care is a mandatory part of the management of surgical patients both in the outpatient and hospital settings of the entire process.

The article is a commented selection of nutritional guidelines of the European Society for Parenteral and Enteral Nutrition (ESPEN) of 2017 for surgical patients, and of those resulting from consensual voting of the working group of the Czech Society for Clinical Nutrition and Intensive Metabolic Care (SKVIMP) of 2018.

Keywords:

perioperative nutrition – surgical patient – guidelines

Zdroje

Studley HO. Percentage of weight loss: a basic indicator of surgical risk in patients with chronic peptic ulcer. JAMA 1936:458−460.
Buzby GP, Mullen JL, Matthews DC, et al. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139:160−167. doi:10.1016/0002-9610(80)90246-9.
Detsky AS, Baker JP, O´Rourke K, et al. Predicting nutrition-associated complications for patients undergoing gastrointestinal surgery. J Parent Enteral Nutr. 1987;11(5):440−446. doi:10.1177/0148607187011005440.
Dempsey DT, Mullen JL, Buzby GP. The link between nutritional status and clinical outcome: can nutritional intervention modify it? Am J Clin Nutr. 1988;47:352−356. doi:10.1093/ajcn/47.2.352.
Daley J, Khuri SF, Henderson W, et al. Risk adjustment of the postoperative mortality rate for the comparative assessment of the quality of surgical care: results of the National Veterans Affairs Surgical Risk Study. Am Coll Surg. 1997;185(4):328−340.
Howard L, Ashley C. Nutrition in the perioperative patient. Annu Rev Nutr. 2003;23:263−282. doi:10.1146/annurev.nutr.23.011702.073353.PMID: 14527336.
Singer P, Blase AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48−79. doi:10.1016/j.clnu.2018.08.037.
Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the provision and assesment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutriton (A.S.P.E.N.). Crit Care Med. 2016;44(2):390−438. doi:10.1186/s13054-020-2739-4.
Weimann A, Braga M, Carli F, et al. ESPEN guidelines: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623V650. doi:10.1016/j.clnu.2017.02.013.
Satinský I, Havel E, Bezděk K, et al. Klinická výživa v chirurgii – doporučení ESPEN s konsenzuálním hlasováním pracovní skupiny SKVIMP. Rozhl Chir. 2018;97(10):P1−P9.
Satinský I, Havel E, Bezděk K, et al. Klinická výživa v chirurgii – doporučení ESPEN s konsenzuálním hlasováním pracovní skupiny SKVIMP. Anest Intenziv Med. 2019;30(2):104−110.
Satinský I, Havel E, Bezděk K, et al. Klinická výživa v chirurgii – doporučení ESPEN s konsenzuálním hlasováním pracovní skupiny SKVIMP. Nutrition News 2020;7(1):7–19.
MacFie J, Woodcock NP, Palmer MD, et al. Oral dietary supplements in pre- and postoperative surgical patients: a prospective and randomized clinical trial. Nutrition 2000;16(9):723−728. doi:10.1016/s0899-9007(00)00377-4.
Burden ST, Hill J, Shaffer JL, et al. An unblinded randomised controlled trial of preoperative oral supplements in colorectal cancer patients. J Hum Nutr Diet 2011;24(5):441−448. doi:10.1111/j.1365-277X.2011.01188.x.
Smedley F, Browling T, James M, et al. Randomized clinical trial of the effects of preoperative and postoperative oral nutritional supplements on clinical course and cost of care. Br J Surg. 2004;91(8):983−990. doi:10.1002/bjs.4578.
Burden S, Todd C, Hill J, et al. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11:CD008879. doi:10.1002/14651858.CD008879.pub2.
Grass F, Bertrand PC, Schaffer JL, et al. Compliance with preoperative oral nutritional supplements in patients at nutritional risk--only a question of will? Eur J Clin Nut. 2015;69(4):525−529. doi:10.1038/ejcn.2014.285.
Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional Risk Screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321−336. doi:10.1016/s0261-5614(02)00214-5.
Stratton RJ, Hackstone A, Longmore D, et al. Malnutrition in hospital outpatients and inpatients: prevalence, concurrent validity and ease of use of the “malnutrition universal screening tool“ (“MUST“) for adults. Br J Nutr. 2004;92:799−808. doi:10.1079/BJN20041258.
Guigos Y, Vellas B, Garry PJ. Assessing the nutritional status of the elderly. The Mini Nutritional Assessment as part of the geriatric evaluation. Nutr Rev. 1996;54(1):S59−S65. doi:10.1111/j.1753-4887.1996.tb03793.
Česká onkologická společnost [online]. Praha: ČOS, 2013 [cit. 24.6.2020]. Available from: https://www.linkos.cz/ceska-onkologicka-spolecnost-cls-jep/organizace-cos/pracovni-skupiny-cos/pracovni-skupina-nutricni-pece-v-onkologii-pri-cos/materialy-pro-praxi-ke-stazeni/.
Skoblej T, Schwarz P, Satinský I. Nové ambulantní možnosti ovlivnění malnutrice chirurgem. Rozhl Chir 2021;100(XX): in press.
Česká chirurgická společnost [online]. Praha: ČCHS, 2020 [cit. 24.6.2020]. Available from: https://www.chirurgie.cz/sekce-spolecnosti/sekce-intenzivni-pece-pro-chirurgii/dokumenty/dokumenty-ke-stazeni/.
Česká společnost klinické výživy a intenzivní metabolické péče [online]. Praha: SKVIMP 2020 [cit. 28.6.2020]. Available from://www.chirurgie.cz/sekce-spolecnosti/sekce-intenzivni-pece-pro-chirurgii/dokumenty/dokumenty-ke-stazeni/.
Státní ústav pro kontrolu léčiv [online]. Praha: SÚKL, 2020 [cit. 24.6.2020]. Available from: https://verso.sukl.cz/fcgi/verso.fpl?fname=vp_pisemnost&_idspis=176815371&_idpis=424072261.
Burden S, Todd C. Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Sys Rev. 2012;11. CD008879.
Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS^©) Society recommendations: 2018. World J Surg. 2019;43(3):659−695. doi:10.1007/s00268-018-4844-y.
Andersen HK, Lewis HK, Thomas S. Early enteral nutrition within 24h of colorectal surgery versus later commencement of feeding for postoperative complications Cochrane Database Syst Rev. 2006;(4):CD004080. doi:10.1002/14651858.CD004080.pub2.
Carrere N, Seulin P, Julio CH, et al. Is nasogastric or nasojejunal decompression necessary after gastrectomy? A prospective randomized trial. World J Surg. 2007;31(1):122−127. doi:10.1007/s00268-006-0430-9.
Ryska O, Šerclová Z, Antoš F, et al. Jak jsou dodržovány postupy moderní perioperační péče (Enhanced Recovery After Surgery) na chirurgických pracovištích v ČR – výsledky národní ankety. Rozhl Chir. 2013;92(8):435−442.
Lassen K, Soop M, Nygren J, et al. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144(10):961−969. doi:10.1001/archsurg.2009.170.
Willcutts KF, Chung MC, Erenberg CL, et al. Early oral feeding as compared with traditional timing of oral feeding after upper gastrointestinal surgery: A systematic review and meta-analysis. Ann Surg. 2016;264(1):54−63. doi:10.1097/SLA.0000000000001644.
Hur H, Kim SG, Shim HJ, et al. Effect of early oral feeding after gastric cancer surgery: a result of randomized clinical trial. Surgery 2011;149(4):561−568. doi:10.1016/j.surg.2010.10.003.
Seven H, Calis AB, Turgut S. A randomized controlled trial of early oral feeding in laryngectomized patients. Laryngoscope 2003 Jun;113(6):1076−1079. doi:10.1097/00005537-200306000-00030.
McClave SA, Martindale RG, Vanek VW, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenter Enteral Nutr. 2009;33(3):277−316. doi:10.1177/0148607109335234.
Ichimaru S. Methods of enteral nutrition administration in critically ill patients: continuous, cyclic, intermittent, and bolus feeding. Nutr Clin Pract. 2018;33(6):790−795. doi:10.1002/ncp.10105.
Yermilov I, Jain S, Sekeris E, et al. Utilization of parenteral nutrition following pancreaticoduodenectomy: is routine jejunostomy tube placement warranted? Dig Dis Sci. 2009;54(7):1582−1588. doi:10.1007/s10620-008-0526-1.
Gerritsen A, Besseling MG, Cieslak KP, et al. Efficacy and complications of nasojejunal, jejunostomy and parenteral feeding after pancreaticoduodenectomy. J Gastrointest Surg. 2012;16(6):1144−1151. doi:10.1007/s11605-012-1887-5.
Dann CC, Squires HM, Postlewait LM, et al. An assessment of feeding jejunostomy tube placement at the time of resection for gastric adenocarcinoma: A seven-institution analysis of 837 patients from the U.S. gastric cancer collaborative. J Surg Oncol. 2015;112(2):195−202. doi:10.1002/jso.23983.
Markides GA, Alkhaffaf B, Vickers J. Nutritional access routes following oesophagectomy--a systematic review. Eur J Clin Nutr. 2011;65(5):565−573. doi:10.1038/ejcn.2010.292.
Zusman O, Theilla M, Cohen J, et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care 2016;20(1):367. doi:10.1186/s13054-016-1538-4.
Gianotti L, Braga M, Biffi R, et al. Perioperative intravenous glutamine supplemetation in major abdominal surgery for cancer: a randomized multicenter trial. Ann Surg. 2009;250(5):684−690. doi:10.1097/SLA.0b013e3181bcb28d.
Braga M, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr. 2009;28(4):378−386. doi:10.1016/j.clnu.2009.04.002.
Chen B, Zhou Y, Yang P, et al. Safety and efficacy of fish oil-enriched parenteral nutrition regimen on postoperative patients undergoing major abdominal surgery: a meta-analysis of randomized controlled trials. J Parenter Enteral Nutr. 2010;34(4):387−394. doi:10.1177/0148607110362532.
Pradelli L, Mayer K, Muscaritoli M, et al. n-3 fatty acid-enriched parenteral nutrition regimens in elective surgical and ICU patients: a meta-analysis. Crit Care 2012;16(5):R184. doi:10.1186/cc11668.
Li NN, Zhou Y, Qin XP, et al. Does intravenous fish oil benefit patients post-surgery? A meta-analysis of randomised controlled trials. Clin Nutr. 2014;33(2):226−239. doi:10.1016/j.clnu.2013.08.013.
Chambrier C, Sztark F. French clinical guidelines on perioperative nutrition – update of the 1994 consensus conference on perioperative artificial nutrition for elective surgery in adults. J Visc Surg. 2012;149(5):e325−336. doi:10.1016/j.jviscsurg.2012.06.006.
Arends J, Bachmann P, Baracos V, Barthelemy N, Berthz H, Fearon K, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11−48. doi:10.1016/j.clnu.2016.07.015.
Nothacker M, Rutters D. Evidenzbericht. Analysen von Metaanalysen zur perioperativen klinischen Ernahrung. Berlin. Arzliches Zentrum fur Qualitat in der Medizin 2012.