Background Enhanced recovery, otherwise known as ‘fast track’ programmes, are evidence based protocols designed to standardise medical care, improve outcomes and lower healthcare costs. One of the main goals in fast track is optimising nutritional support and avoiding starvation to minimise negative protein balance. The consequences of preoperative malnutrition on postoperative recovery are important, detecting a clear relationship between loss of weight and morbidity and mortality.
Purpose The aim of our study was to establish a programme of nutritional assessment and preoperative management in patients undergoing colorectal resection in an enhanced recovery (ERAS) protocol.
Material and methods A multidisciplinary team was established comprising a surgeon, pharmacist and nurse. We performed a bibliographic search. We encountered various tools to perform a nutritional assessment. We analysed different tools and finally selected for our population the subjective global assessment (SGA), which defines the nutritional and functional status of patients with the aim of identifying who could benefit from a nutritional intervention. Nutritional risk index (NRI) is an adequate tool to identify patients with a nutritional risk and who would benefit from a nutritional intervention aimed at preventing associated complications. NRI included serum albumin, weight and ideal body weight. SGA included body weight, body weight change, dietary intake and change, gastrointestinal symptoms and functionality, along with a physical examination of sites related to subcutaneous fat and muscle mass.
Results Colorectal cancer patients who were candidates for surgical intervention were selected in the medical consultation. In this moment, nutritional and analytical parameters were determined: serum protein, albumin, prealbumin, transferrin, zinc, haemoglobin, leukocytes, lymphocytes, procalcitonin and C reactive protein. Within a week, patients were seen in consultation with the pharmacist and nutritional assessment (NA) was performed, which included mid-arm circumference (cm) and triceps skinfold thickness (mm). The NA was performed a minimum of 7–10 days before surgery. First, NRI was performed. If the score was < 100, the SGA questionnaire was done. Depending on the result obtained, patients received nutritional intake recommendations or oral nutritional supplementation.
Conclusion We have established a programme of nutritional assessment and preoperative management in patients undergoing colorectal resection in an ERAS protocol with the aim of improving the nutritional status of the patients and, therefore, reduce postoperative complications.
References and/or acknowledgements Adejumo OL, Koelling TM, Hummel SL. Nutritional risk index predicts mortality in hospitalised advanced heart failure patients. J Heart Lung Transplant2015;34:1385–9.
No conflict of interest
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