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The nutritional management of surgical patients: enhanced recovery after surgery

Published online by Cambridge University Press:  07 March 2007

Kenneth C. H. Fearon  and
Rachel Luff
Rachel Luff
Affiliation:
Department of Clinical and Surgical Sciences (Surgery), School of Clinical Sciences and Community Health, The University of Edinburgh, Room F3307, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 45A, UK
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Abstract

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Malnutrition has long been recognised as a risk factor for post-operative morbidity and mortality. Traditional metabolic and nutritional care of patients undergoing major elective surgery has emphasised pre-operative fasting and re-introduction of oral nutrition 3–5 d after surgery. Attempts to attenuate the consequent nutritional deficit and to influence post-operative morbidity and mortality have included parenteral, enteral and oral sip feeding. Recent studies have emphasised that an enhanced rate of recovery can be achieved by a multi-modal approach focused on modulating the metabolic status of the patient before (e.g. carbohydrate and fluid loading), during (e.g. epidural anaesthesia) and after (e.g. early oral feeding) surgery. Using such an approach preliminary results on patients undergoing elective colo-rectal surgery indicate a significant reduction in hospital stay (traditional care, n 48, median stay 10 d v. enhanced recovery programme, n 33, median stay 7d; P<0·01) can be achieved. Such findings emphasise the potential role of multi-modal care programmes in the promotion of early recovery from major surgical trauma.

Keywords

Pre-operative fastingPost-operative nutritional supportEnhanced recovery after surgery
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 62 , Issue 4 , November 2003 , pp. 807 - 811
Copyright
Copyright © The Nutrition Society 2003

References

Basse, L, Hjort Jakobsen, D, Billesbolle, P, Werner, M & Kehlet, H (2000) A clinical pathway to accelerate recovery after colonic resection. Annals of Surgery 232, 51–57.CrossRefGoogle ScholarPubMed
Beattie, AH, Prach, AT, Baxter, JP & Pennington, CR (2000) A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut 46, 813–818.CrossRefGoogle ScholarPubMed
Fasting, S, Soreide, E & Raeder, JC (1998) Changing preoperative fasting policies. Impact of a national consensus. Acta Anaesthesiologica Scandinavica 42, 1188–1191.CrossRefGoogle ScholarPubMed
Frost, A, Wakefield, CH, Sengupta, F & Fearon, K (2001) Relationship between fluid administrations and outcome in colorectal surgery. Proceedings of the Nutrition Society 60, 113A.Google Scholar
Gottschlich, MM, Jenkins, ME, Mayes, T, Khoury, J, Kagan, RJ & Warden, GD (2000) An evaluation of the safety of early vs delayed enteral support and effects on clinical, nutritional, and endocrine outcomes after severe burns. Journal of Burn Care and Rehabilitation 23, 401–415.CrossRefGoogle Scholar
Heslin, MJ, Latkany, L, Leung, D, Brooks, AD, Hochwald, SN, Pisters, PW, Shike, M & Brennan, MF (1997a) A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy. Annals of Surgery 226, 567–577.CrossRefGoogle ScholarPubMed
Heslin, MJ, Latkany, L, Leung, D, Brooks, AD, Hochwald, SN, Pisters, PW, Shike, M & Brennan, MF (1997b) A prospective, randomized trial of early enteral feeding after resection of upper gastrointestinal malignancy: discussion. Annals of Surgery 226, 577–580.CrossRefGoogle Scholar
Heyland, DK, MacDonald, S, Keefe, L & Drover, JW (1998) Total parenteral nutrition in the critically ill patient: a meta-analysis. Journal of the American Medical Association 280, 2013–2019.CrossRefGoogle ScholarPubMed
Keys, SD, Walker, LG, Smith, I & Eremin, O (1999) Enteral nutritional supplementation with key nutrients in patients with critical illness and cancer: a meta-analysis of randomized controlled clinical trials. Annals of Surgery 229, 467–477.Google Scholar
Hill, GL (1994) Changes in body composition and outcome in surgical patients. Clinical Nutrition 13, 331–340.CrossRefGoogle Scholar
Holte, K & Kehlet, H (2002) Epidural anaesthesia and analgesia – effects on surgical stress responses and implications for postoperative nutrition. Clinical Nutrition 21, 199–206.CrossRefGoogle ScholarPubMed
Jeejeebhoy, KN (2001) Enteral and parenteral nutrition: evidence-based approach. Proceedings of the Nutrition Society 60, 399–402.CrossRefGoogle ScholarPubMed
Kudsk, KA, Croce, MA, Fabian, TC, Minard, G, Tolley, EA, Poret, HA, Kuhl, MR & Brown, RO (1992a) Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Annals of Surgery 215, 503–511.CrossRefGoogle ScholarPubMed
Kudsk, KA, Croce, MA, Fabian, TC, Minard, G, Tolley, EA, Poret, HA, Kuhl, MR & Brown, RO (1992b) Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma: discussion. Annals of Surgery 215, 511–513.CrossRefGoogle Scholar
Ljungqvist, O, Nygren, J & Thorell, A (2002) Modulation of post-operative insulin resistance by pre-operative carbohydrate loading. Proceedings of the Nutrition Society 61, 329–335.CrossRefGoogle ScholarPubMed
Lobo, DN, Bostock, KA, Neal, KR, Perkins, AC, Rowlands, BJ & Allison, SP (2002) Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet 359, 1812–1818.Google Scholar
Pettigrew, RA & Hill, GL (1986) Indicators of surgical risk and clinical judgement. British Journal of Surgery 73, 47–51.Google Scholar
Rodgers, A, Walker, N, Schug, S, McKee, A, Kehlet, H, Van Zundert, A, Sage, D, Futter, M, Saville, G, Clark, T & MacMahon, S (2002) Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. British MedicalJournal 321, 1493.CrossRefGoogle Scholar
Santos, JC Jr, Batista, J, Sirimarco, MT, Guimaraes, AS & Levy, CE (1994) Prospective randomized trial of mechanical bowel preparation in patients undergoing elective colorectal surgery. British Journal of Surgery 81, 1673–1676.CrossRefGoogle ScholarPubMed
Sarr, MG (1999) Appropriate use, complications and advantages demonstrated in 500 consecutive needle catheter jejunostomies. British Journal of Surgery 86, 557–561.Google Scholar
Smith, RC, Hartemink, RJ, Hollinshead, JW & Gillett, DJ (1985) Fine bore jejunostomy feeding following major abdominal surgery: a controlled randomized clinical trial. British Journal of Surgery 72, 458–461.CrossRefGoogle ScholarPubMed
Studley, HO (1936) Percentage of weight loss. A basic indicator of surgical risk in patients with chronic peptic ulcer. Journal of the American Medical Association 106, 458–460.CrossRefGoogle Scholar
Watters, JM, Kirkpatrick, SM, Norris, SB, Shamji, FM & Wells, GA (1997a) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility. Annals of Surgery 226, 369–377.Google Scholar
Watters, JM, Kirkpatrick, SM, Norris, SB, Shamji, FM & Wells, GA (1997b) Immediate postoperative enteral feeding results in impaired respiratory mechanics and decreased mobility: discussion. Annals of Surgery 226, 377–380.CrossRefGoogle Scholar