P-OGC05 The introduction of an Upper Gastrointestinal (UGI) specific menu can reduce the need for routine jejunostomy (JEJ) placement following UGI Cancer resection

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Vida Dossou
Keyword(s):  
Patient Satisfaction ◽  
Staff Training ◽  
Nutritional Support ◽  
Enhanced Recovery ◽  
Oral Intake ◽  
Oral Feeding ◽  
Ward Staff ◽  
Cancer Resection ◽  
Early Oral Feeding ◽  
Satisfaction Surveys

Abstract Background Despite the fact that early oral feeding (EOF) after the surgical resection of oesophageal and gastric tumours is safe, and is associated with favourable early in-hospital outcomes, sooner return to physiological GI function and hospital discharge, there can still be some reluctance in establishing EOF. Concerns remain around risk of anastomotic leak, pneumonia, Naso-gastric tube (NGT) reinsertion, re-operation, readmissions and mortality. However, when utilising EOF, a reduction in length of stay, earlier removal of NGT and earlier initiation of soft diet can be observed. JEJ placement is beneficial however  complications can arise and the optimal nutritional pathway remains debatable.  Methods Patient satisfaction surveys were conducted amongst UGI Cancer patients following Cancer resection and analysed pre and post UGI menu development and staff training. Expert UGI Patient volunteers assisted in the UGI menu development through food tastings producing a new menu in collaboration with the catering department. The new menu was launched and an UGI snack box provided to the UGI Enhanced Recovery Unit (ERAS).  Oral intake of Diet and Oral Nutritional Support was analysed for calorie and protein content post menu change, ward staff training and specialist UGI dietetic counselling. This was then compared with calculated minimum estimated nutritional requirements.  Results Of the ten patients audited pre discharge: Remaining 1 patient achieved 51% of protein requirements, below the aim of 60%. No patient audited required supplementary Enteral feeding via JEJ or Naso-jejunal tube Patient satisfaction surveys were completed prior to catering staff training and menu revision, after the new menu was implemented. The results show a significant improvement in patient satisfaction following UGI menu implementation. Conclusions Specialist UGI RD support, UGI specific menu and Oral Nutritional Support can reduce the need for routine JEJ placement in favour of on an individual patient basis.  Collaborative working between UGI Dietitians, Ward staff, Catering staff and Expert patients is required for UGI specific menu development to be effectual.  This audit is limited to small numbers due to adapted operational procedures during the pandemic. This audit will be repeated on a larger scale to yield more meaningful data.   Future audit will capture data on how many UGI patients went on to require enteral nutritional support with three months of discharge.

scholarly journals Ordering a Normal Diet at the End of Surgery—Justified or Overhasty?

Nutrients ◽  
2018 ◽  
Vol 10 (11) ◽  
pp. 1758 ◽  
Author(s):  
Fabian Grass ◽  
Martin Hübner ◽  
Jenna Lovely ◽  
Jacopo Crippa ◽  
Kellie Mathis ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Outcome Data ◽  
Normal Diet ◽  
Oral Feeding ◽  
Prolonged Length ◽  
Early Oral Feeding ◽  
American Society ◽  
Independent Decision ◽  
Recovery Pathways

Early re-alimentation is advocated by enhanced recovery pathways (ERP). This study aimed to assess compliance to ERP-set early re-alimentation policy and to compare outcomes of early fed patients and patients in whom early feeding was withhold due to the independent decision making of the surgeon. For this purpose, demographic, surgical and outcome data of all consecutive elective colorectal surgical procedures (2011–2016) were retrieved from a prospectively maintained institutional ERP database. The primary endpoint was postoperative ileus (POI). Surgical 30-day outcome and length of stay were compared between patients undergoing the pathway-intended early re-alimentation pattern and patients in whom early re-alimentation was not compliant. Out of the 7103 patients included, 1241 (17.4%) were not compliant with ERP re-alimentation. Patients with delayed re-alimentation presented with more postoperative complications (37 vs. 21%, p < 0.001) and a prolonged length of hospital stay (8 ± 7 vs. 5 ± 4 days, p < 0.001). While male gender (odds ratio (OR) 1.24; 95% confidence interval (CI) 1.04–1.32), fluid overload (OR 1.38; 95% CI 1.16–1.65) and high American Society of Anaesthesiologists (ASA) score (OR 1.51; 95% CI 1.27–1.8) were independent risk factors for POI, laparoscopy (OR 0.51; 95% CI 0.38–0.68) and ERP compliant diet (OR 0.46; 95% CI 0.36–0.6) were both protective. Hence, this study provides further evidence of the beneficial effect of early oral feeding after colorectal surgery.

scholarly journals Impact of Enhanced Recovery after Surgery with Preoperative Whey Protein-Infused Carbohydrate Loading and Postoperative Early Oral Feeding among Surgical Gynecologic Cancer Patients: An Open-Labelled Randomized Controlled Trial

Nutrients ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 264 ◽  
Author(s):  
Ho Chiou Yi ◽  
Zuriati Ibrahim ◽  
Zalina Abu Zaid ◽  
Zulfitri ‘Azuan Mat Daud ◽  
Nor Baizura Md. Yusop ◽  
...  
Keyword(s):  
Whey Protein ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Gynecologic Cancer ◽  
Intervention Group ◽  
Oral Feeding ◽  
Control Group ◽  
Early Oral Feeding ◽  
Significant Difference ◽  
The Impact

Enhanced Recovery after Surgery (ERAS) with sole carbohydrate (CHO) loading and postoperative early oral feeding (POEOF) shortened the length of postoperative (PO) hospital stays (LPOHS) without increasing complications. This study aimed to examine the impact of ERAS with preoperative whey protein-infused CHO loading and POEOF among surgical gynecologic cancer (GC) patients. There were 62 subjects in the intervention group (CHO-P), which received preoperative whey protein-infused CHO loading and POEOF; and 56 subjects formed the control group (CO), which was given usual care. The mean age was 49.5 ± 12.2 years (CHO-P) and 51.2 ± 11.9 years (CO). The trial found significant positive results which included shorter LPOHS (78.13 ± 33.05 vs. 99.49 ± 22.54 h); a lower readmission rate within one month PO (6% vs. 16%); lower weight loss (−0.3 ± 2.3 kg vs. −2.1 ± 2.3 kg); a lower C-reactive protein–albumin ratio (0.3 ± 1.2 vs. 1.1 ± 2.6); preserved muscle mass (0.4 ± 1.7 kg vs. −0.7 ± 2.6 kg); and better handgrip strength (0.6 ± 4.3 kg vs. −1.9 ± 4.7 kg) among CHO-P as compared with CO. However, there was no significant difference in mid-upper arm circumference and serum albumin level upon discharge. ERAS with preoperative whey protein-infused CHO loading and POEOF assured better PO outcomes.

Intolerance to early oral feeding in enhanced recovery after colorectal surgery: an early red flag?

2019 ◽  
Vol 22 (1) ◽  
pp. 95-101 ◽  
Author(s):  
K. Slim ◽  
T. Reymond ◽  
J. Joris ◽  
S. Paul ◽  
B. Pereira ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Enhanced Recovery ◽  
Oral Feeding ◽  
Early Oral Feeding ◽  
Red Flag

131 PRACTICES IN PERIOPERATIVE NUTRITION PRECEDING OR FOLLOWING OESOPHAGECTOMY: RESULTS OF A EUROPEAN SURVEY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Hans Van Veer ◽  
Misha Luyer ◽  
Lieven Depypere ◽  
Philippe Nafteux ◽  
Willy Coosemans
Keyword(s):  
Nutritional Support ◽  
Nutritional Assessment ◽  
Enhanced Recovery ◽  
Oral Intake ◽  
Daily Practice ◽  
The Third ◽  
Preoperative Nutrition ◽  
Perioperative Nutrition ◽  
Feeding Regimen ◽  
Surgical Pathway

Abstract   The route and type of peri-operative feeding after oesophagectomy varies widely across centres, usually based on local experiences and standing orders. The aim of this survey on perioperative nutrition after oesophagectomy (PONOS) was to create a snapshot the way perioperative nutrition preceding or following oesophagectomy is established across reference centres in Europe, and what the reasons are for preferring one method over another. Methods A survey consisting of four parts was distributed to the membership of 3 European, mainly surgical oriented scientific societies between October 2019 and January 2020. The first part contained some general questions regarding demographics of the participants and type of performed surgery. In the second section, centres were asked about practices in preoperative nutrition. The third section questioned participants about their practices in postoperative nutrition; in the last part the daily practice was reflected against the current available ESPEN guidelines. Results Fifty-one surgeons from 49 centres in 16 countries participated. The majority had a structured nutrition team in their institution. An Enhanced Recovery Pathway was implemented in 2/3 of centres. ESPEN guidelines were followed in 50% of centers. Routine preoperative nutritional assessment was performed in 84%. Preoperative nutritional support consisted mainly of enteral and oral support; immediate postoperatively mostly a combination of oral and enteral or enteral only; at discharge mostly a combination of oral and enteral or only oral nutritional supplementation were used. Timing, definition and means of postoperative oral intake also seemed to differ widely across centres. Conclusion The PONOS survey confirmed our assumption that perioperative feeding after oesophagectomy exists in a wide variety across European centres performing oesophageal resections for cancer. Survey based feedback to the surgical community draws attention to this often underexposed part of the surgical pathway of a patient. As such, this might further enhance the exchange of experiences in order to try to harmonise peri-operative feeding regimen.

scholarly journals The Efficacy of Injection of 0.25 mg/kg Dexamethasone after Induction of Anesthesia on Reducing Tonsillectomy Morbidities.

2015 ◽  
Vol 22 (3) ◽  
pp. 1-7
Author(s):  
Saad M. Al Muhayawi
Keyword(s):  
Single Dose ◽  
Oral Intake ◽  
Cross Sectional Study ◽  
Oral Feeding ◽  
University Hospital ◽  
Control Group ◽  
Cross Sectional ◽  
Early Oral Feeding ◽  
King Abdulaziz University ◽  
Post Operative Nausea

Tonsillectomy is one of the most commonly performed surgical procedures in otolaryngology practice. Nausea, vomiting, pain, decreased oral intake and dehydration are frequently associated with tonsillectomy. This study demonstrates the effect of prophylactic administration of dexamethasone as a single dose on post tonsillectomy morbidities. This was a comparative cross-sectional study of pediatric patients (3-15 years) attending the otolaryngology outpatient clinics at King Abdulaziz University Hospital between October 2010 and December 2012. A sample of 100 patients, divided into two groups of 50 patients was included for analysis. The first group received intravenous dexamethasone (0.25 mg/kg) as a single dose with induction of anesthesia. In the second, control, group, no pre-operative dexamethasone was administered. The outcome was assessed by a questionnaire distributed to both groups to evaluate post-operative nausea, vomiting, pain and early oral feeding. Pain score was assessed using a visual analogue scale (ranging from 0 to 10. Our results showed a statistically significant reduction in morbidity associated with tonsillectomy, supporting the administration of single dose intravenous dexamethasone during tonsillectomy.  

scholarly journals Integrated nutrition

2005 ◽  
Vol 64 (3) ◽  
pp. 319-323 ◽  
Author(s):  
S. P. Allison
Keyword(s):  
Nutritional Support ◽  
Enhanced Recovery ◽  
Mode Of Delivery ◽  
Oral Intake ◽  
Later Life ◽  
Scientific Discipline ◽  
Clinical Nutrition ◽  
Electrolyte Balance ◽  
Fully Integrated ◽  
Beneficial Effects

There is no branch of medicine in which nutritional considerations do not play some part. Overnutrition, undernutrition or unbalanced nutrition are the major causes of ill health in the world. Conversely, illness causes important nutritional and metabolic problems. The spectrum from lack to excess of nutrients is seamless as a clinical and scientific discipline, the two extremes being linked by the Barker effect by which intrauterine malnutrition and low birth weight predispose to obesity, diabetes and CVD in later life. However, the teaching of nutrition in medical and nursing schools remains sparse. Nutritional care cannot be practised satisfactorily in isolation from other aspects of management, since factors such as drugs, surgery and fluid and electrolyte balance affect nutritional status. Nutritional treatment may also have adverse or beneficial effects according to the composition, amount and mode of delivery of the diet and the clinical context in which it is given. Any benefits of nutritional support may also be negated by shortcomings in other aspects of treatment and must therefore be fully integrated into overall care. One example of this approach is the enhanced recovery after a surgery protocol incorporating immediate pre-operative carbohydrate and early post-operative oral intake with strict attention to zero fluid balance, epidural analgesia and early mobilisation. Other examples include the deleterious effect on surgical outcome of salt and water overload or hyperglycaemia, either of which may negate the benefits of nutritional support. There is a need, therefore, to integrate clinical nutrition more closely, not just into medical and surgical practice, but also into the organisation of health services in the hospital and the community, and into the training of doctors and nurses. Societies originally devoted to parenteral and enteral nutrition need to widen their scope to embrace wider aspects of clinical nutrition.

Safety and efficacy of early oral feeding for enhanced recovery following gastrectomy for gastric cancer: A systematic review

2019 ◽  
Vol 28 ◽  
pp. 88-95 ◽  
Author(s):  
Thaís Tweed ◽  
Yara van Eijden ◽  
Juul Tegels ◽  
Hylke Brenkman ◽  
Jelle Ruurda ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Systematic Review ◽  
Enhanced Recovery ◽  
Oral Feeding ◽  
Safety And Efficacy ◽  
Early Oral Feeding

scholarly journals EARLY ORAL FEEDING POST-UPPER GASTROINTESTINAL TRACT RESECTION AND PRIMARY ANASTOMOSIS IN ONCOLOGY

2018 ◽  
Vol 31 (1) ◽  
Author(s):  
Lilian Pinheiro LOPES ◽  
Taysa Machado MENEZES ◽  
Diogo Oliveira TOLEDO ◽  
Antônio Talvane Torres DE-OLIVEIRA ◽  
Adhemar LONGATTO-FILHO ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Total Gastrectomy ◽  
Primary Anastomosis ◽  
Gastrointestinal Surgery ◽  
Oral Intake ◽  
Wound Dehiscence ◽  
Oral Feeding ◽  
Oral Nutrition ◽  
Early Oral Feeding ◽  
Upper Gastrointestinal

ABSTRACT Background: The practice of starving patients in the immediate period after upper gastrointestinal surgery is widespread. Early oral intake has been shown to be feasible and may result in faster recovery and decrease length of hospital. Aim: To evaluate the feasibility and safety of oral nutrition on postoperative early feeding after upper gastrointestinal surgeries. Methods: Observational cohort design study with convenience retrospective data in both genders, over 18 years, undergoing to total gastrectomy and/or elective esophagectomy. They have received oral or enteral nutrition in less than 48 h after surgery, and among those who started with enteral nutrition, the oral feeding up to seven days. Results: The study was performed in 161 patients, 24 (14.9%) submitted to esophagectomy, 132 (82%) to total gastrectomy and five (3.1%) to esophagogastrectomy. Was observed good dietary acceptance and low percentage (29%) of gastrointestinal intolerances, more pronounced among those with enteral diet. Most of the patients did not present postoperative complications, 11 (6.8%) were reopened, five (3.1%) had fistulas, three (1.9%) wound dehiscence, three (1.9%) fistula more wound dehiscence and six (3.7%) other non-infectious complications. Conclusion: Early oral diet is safe and viable for patients undergoing upper gastrointestinal surgery.

Five-Year Experience of Early Enteral Feeding in Patients Undergoing Allogeneic Stem Cell Transplantation Following Myeloablative Conditioning.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3004-3004
Author(s):  
David Seguy ◽  
Majd Ben Rejeb ◽  
Valerie Coiteux ◽  
Caroline Dendoncker ◽  
Helene Baudelle ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Median Duration ◽  
Enteral Feeding ◽  
Nutritional Support ◽  
Energy Requirement ◽  
Oral Intake ◽  
Oral Feeding ◽  
Second Period

Abstract Since the early 2003 with the encouraging preliminary results of our pivotal study (Seguy, transplantation), all pts refereed to our unit for myeloablative Allogenic Stem Cell Transplantation (allo-CST) were offered right away enteral feeding via a naso-gastric tube (NGT). The aim of this work was to investigate the evolution of our practices regarding nutritional support and its impact on early outcomes over the last five years. During a systematic individual pre-transplantation interview, all pts were provided with comprehensive information regarding NGT feeding. They received advice on an ongoing basis from a multidisciplinary team. Between Jan 01 and Dec 05, 121 pts who underwent myeloablative allo-SCT were offered EN. Among them, 94 (78%) agreed to receive EN (EN group) and 27 (22%) refused the NGT (without EN group: WEN group) and received either parenteral nutrition (PN) (n=22) or oral feeding only (n=5). The NGT was inserted shortly after transplantation. Bacteriological high-controlled oral diet intake was encouraged for as long as the patient was able to sustain it. The daily oral intake was scheduled to provide 100% of estimated requirements for energy (30–35 kcal/kg/day). Overnight NGT feeding, was gradually increased depending on the patient’s tolerance in order to reach 50–70% of energy requirement within 5 days. In case of intolerance toward EN, additional or total PN was given. In the WEN group, pts received PN when total oral intake was less than two-thirds of the average energy requirement over 5 days. Except for the pts’ age (EN-group, 38y vs WEN 28y, p=.038), the two groups were comparable in terms of initial pts’ characteristics and transplantation modalities. Median duration of EN was 14 days (1–59) and 61 pts received no additional PN while the median duration of the PN was 12 days (2–70). There was no significant difference between the two groups regarding duration of hospitalization, nutritional status at discharge and duration and grade of mucositis. Significant differences were observed, however: engraftment, 100% vs 93%, p=.05, duration of neutropenia, 20d (10–64) vs 25d (18–100), p=.0001 and thrombopenia 27d (6–100) vs 56d (50–100), p=.014; serum albumine level at discharge < 35g/L, 45% vs 76%, p=.005 for EN-group vs WEN-group, respectively. Pts with EN developed less often acute grade III/IV GVHD (9% vs 37%; p=0.001) and non-bacterial infections (9% vs 41%; p=.0002). In addition, pts with enteral feeding had better 100-day survival (92% vs. 67%, P=0.001) with less infection-related deaths. In multivariate analysis the absence of enteral nutrition was the only factor adversely influencing 100-day survival (CI 95%: 1.55–14.9 0.646; P=.007). In order to evaluate the practices over time regarding nutritional support in our unit, we compared the initial period (2001–02) when pts (n=41) had the choice between EN and PN with the second period (2003–05) when EN was offered systematically (n=80). In the second period, pts received less often PN (73% vs. 31%, p<.0001) and more often EN (49% vs. 93%, p<.0001) with longer duration (10d vs. 15d; p=.001). In addition, EN started earlier after transplantation (5d vs 2d, p=.004). CONCLUSION: EN has been well tolerated and dramatically reduced the proportion of pts requiring PN. This study confirms the positive impact of EN on early outcome of pts undergoing myeloablative allo-CST. When possible EN should be preferred to PN.

scholarly journals ENHANCED RECOVERY (ERAS) AFTER LIVER SURGERY:COMPARATIVE STUDY IN A BRAZILIAN TERCIARY CENTER

2019 ◽  
Vol 32 (1) ◽  
Author(s):  
Uirá Fernandes TEIXEIRA ◽  
Marcos Bertozzi GOLDONI ◽  
Fábio Luiz WAECHTER ◽  
José Artur SAMPAIO ◽  
Florentino Fernandes MENDES ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Surgical Stress ◽  
Length Of Hospital Stay ◽  
Early Mobilization ◽  
Oral Feeding ◽  
Control Group ◽  
Colonic Surgery ◽  
Early Oral Feeding ◽  
Tertiary Center ◽  
Eras Protocol

ABSTRACT Background: After the publication of the first recommendations of ERAS Society regarding colonic surgery, the proposal of surgical stress reduction, maintenance of physiological functions and optimized recovery was expanded to other surgical specialties, with minimal variations. Aim: To analyze the implementation of ERAS protocols for liver surgery in a tertiary center. Methods: Fifty patients that underwent elective hepatic surgery were retrospectively evaluated, using medical records data, from June 2014 to August 2016. After September 2016, 35 patients were prospectively evaluated and managed in accordance with ERAS protocol. Results: There was no difference in age, type of hepatectomy, laparoscopic surgery and postoperative complications between the groups. In ERAS group, it was observed a reduction in preoperative fasting and in the length of hospital stay by two days (p< 0.001). Carbohydrate loading, j-shaped incision, early oral feeding, postoperative prevention of nausea and vomiting and early mobilization were also significantly related to ERAS group. Oral bowel preparation, pre-anesthetic medication, sub-costal incision, prophylactic nasogastric intubation and abdominal drainage were more common in control group. Conclusion: Implementation of ERAS protocol is feasible and beneficial for health institutions and patients, without increasing morbidity and mortality.

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