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

2021 ◽  
Vol 100 (2) ◽  
Keyword(s):  
Perioperative Period ◽  
The Elderly ◽  
Nutrition Therapy ◽  
Outpatient Setting ◽  
Surgical Patients ◽  
Successful Outcome ◽  
Nutrition Care ◽  
Nutritional Guidelines ◽  
Perioperative Nutrition ◽  
Czech Society

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.

New options for surgeons to improve malnutrition in the outpatient setting

2021 ◽  
Vol 100 (2) ◽  
Keyword(s):  
Health Insurance ◽  
Nutritional Status ◽  
Perioperative Period ◽  
Outpatient Setting ◽  
Surgical Patients ◽  
Insurance Companies ◽  
Negative Factor ◽  
Health Insurance Companies ◽  
Limited Period

Malnutrition is a significant negative factor for surgical patients in the entire perioperative period. However, this factor can be controlled and is easy to detect in the outpatient setting. Starting from May 1, 2020, surgeons have the possibility to prescribe sipping under certain conditions for a limited period of 4 weeks. Thereby they have become able to strongly impact any altered nutritional status both preoperatively and postoperatively. The authors describe scoring questionnaires used for the detection of malnutrition and required by health insurance companies. Additionally, prescribing conditions and potential mistakes in the outpatient setting are analysed.

scholarly journals Chirurginių ligonių perioperacinis maitinimas: ar jis reikalingas?

2003 ◽  
Vol 1 (2) ◽  
pp. 0-0
Author(s):  
Saulius Bradulskis ◽  
Kęstutis Adamonis
Keyword(s):  
Hospital Stay ◽  
Perioperative Period ◽  
Surgical Patients ◽  
Negative Consequences ◽  
Preoperative Period ◽  
Septic Complications ◽  
Preoperative Administration ◽  
Perioperative Nutrition ◽  
Tract Secretion ◽  
Nutrition Disorders

Saulius Bradulskis1, Kęstutis Adamonis21 Kauno medicinos universiteto Bendrosios chirurgijos klinika,Josvainių g. 2, LT-3021 Kaunas.2 Kauno medicinos universiteto Gastroenterologijos klinika,Eivenių g. 2, LT-3007 Kaunas.El paštas: [email protected] Įvadas / tikslas Straipsnyje aptariama chirurginių ligonių mitybos nepakankamumo problema. Rezultatai Mitybos nepakankamumas nustatomas nuo 27 iki 50 % šių ligonių. Jis gali būti viena iš svarbiausių pooperacinių komplikacijų, ilgesnio buvimo stacionare pooperaciniu laikotarpiu, papildomų gydymo išlaidų priežastimi. Mitybos korekcija, o ypač maitinimas imuniniais mišiniais, akivaizdžiai padeda spręsti šias problemas. Bereikalingas badavimas prieš operaciją sukelia neigiamų padarinių: sumažėja seilių ir virškinimo trakto sulčių sekrecija, slopinama žarnyno motorika, blogėja kraujo cirkuliacija, padidėja sąlyginai patogeninės žarnų floros virulentiškumas, atrofuojasi gleivinė, padidėja bakterinės translokacijos iš žarnos galimybė, sumažėja antioksidantų, flavonoidų, fitoestrogenų kiekis, slopinamas imunitetas. Badavimas prieš operaciją yra susijęs su pooperaciniu atsparumu insulinui, tiksliau – jo intensyvumu. Prieš operaciją skiriant ligoniui lengvai pasisavinamų angliavandenių, pavyzdžiui, gliukozės, galima sumažinti šio reiškinio intensyvumą pooperaciniu laikotarpiu. Išvados Prieš operaciją ir po jos būtina griežtai laikytis mitybos korekcijos indikacijų, nes kitu atveju ši gydymo procedūra gali būti ne tik nenaudinga, bet ir sukelti komplikaciju, padidinti gydymo išlaidas. Prasminiai žodžiai: perioperacinis laikotarpis, enterinis maitinimas. Perioperative nutrition of surgical patiens: is it necessary? Saulius Bradulskis1, Kęstutis Adamonis2 Background / objective Problems of surgical patients nutrition, pre- and postoperative nutritional problems are discussed. Results Nutrition disorders among surgical patients are frequent – from 50 to 27%. Nutritional disorders may be one of the reasons for complications and long in-hospital stay and additional expenses. Nutritional correction, especially immunonutrition, is beneficial to surgical patients, as it decreases septic complications, in-hospital stay and it helps to save, money. Lack of nutrition has negative consequences: inhibition of digestive tract secretion, motility, splanchnic circulation, increased virulence of pathogenic flora, atrophy of the mucosae, microbial translocation. Data that have become available show that the preoperative administration of carbohydrates to patients undergoing surgery has metabolic benefits postoperatively by reducing postoperative insulin resistance. Conclusions Pre- and postoperative nutritional correction has strong indications, and nonobservance of this indication prolongs in-hospital stay and the preoperative period, as well as increases expenses, and first of all it has no influence on the postoperative complications. Keywords: perioperative period, enteral nutrition.

scholarly journals Perioperative nutrition care and dietetic practices in the scope of bariatric surgery in Saudi Arabia using adapted protocols for evaluation

2021 ◽  
Vol 9 ◽  
pp. 205031212110361
Author(s):  
Elham Abbas Aljaaly
Keyword(s):  
Bariatric Surgery ◽  
Saudi Arabia ◽  
Care Process ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Nutrition Risk ◽  
Nutrition Care ◽  
Management Protocol ◽  
Perioperative Nutrition

Objectives: This study evaluates the availability of perioperative nutritional care protocols and the practices of bariatric registered dietitians in Saudi Arabia. The primary outcomes of the study were conducted using an adapted American survey “with permission.” Methods: A cross-sectional survey of a selected 32 dietitians providing bariatric services completed a self-administered online questionnaire from 12 hospitals in Jeddah, Saudi Arabia. Results: All surveyed dietitians were females, mainly Saudi nationals (93.9%, n = 30), and accredited by the Saudi Commission for Health Specialties (93.8%, n = 30). Only 37.5% (n = 6) of the dietitians were specialized in bariatric surgery. Perioperative common practices of dietitians included a conduct of screening for nutrition risk before (44%, n = 14) and after surgery (62.5%, n = 20) and applied a nutrition management protocol that is mainly based on the application of nutrition care process (62.5%, n = 20). Dietitians (81%, n = 26) reported the importance of having standardized protocols for nutritional management of patients undoing bariatric surgery, where 69% (n = 22) confirmed the availability of pre-operative written protocols in hospitals and 75% (n = 24) confirmed the existence of post-operative protocols. Pre-operative practices included using approaches for weight loss before surgery, for example, very low and low-calorie diet. Dietitians (25%, n = 8) see two to ten patients per month. The sleeve gastrectomy procedure is the most often performed surgery. Conclusion: This is the first study to evaluate the perioperative nutrition care protocols and practices related to bariatric surgery in Saudi Arabia. Perioperative bariatric protocols are available, but some dietitians are not aware of their availability and contents. Researchers emphasize the importance of creating national protocols by the Saudi Credentials Body to standardize practices within the field.

scholarly journals Commentary: Quality nutrition care is integral to the Oncology Care Model

2021 ◽  
Author(s):  
Mary Beth Arensberg ◽  
Beth Besecker ◽  
Laura Weldishofer ◽  
Susan Drawert
Keyword(s):  
Best Practice ◽  
Treatment Guidelines ◽  
Nutrition Therapy ◽  
Care Model ◽  
Nutrition Care ◽  
Ambulatory Oncology ◽  
Oncology Care ◽  
Improvement Programs ◽  
And Performance ◽  
Registered Dietitian Nutritionists

AbstractThe Oncology Care Model (OCM) is a US Centers for Medicare & Medicaid Services (CMS) specialty model implemented in 2016, to provide higher quality, more highly coordinated oncology care at the same or lower costs. Under the OCM, oncology clinics enter into payment arrangements that include financial and performance accountability for patients receiving chemotherapy treatment. In addition, OCM clinics commit to providing enhanced services to Medicare beneficiaries, including care coordination, navigation, and following national treatment guidelines. Nutrition is a component of best-practice cancer care, yet it may not be addressed by OCM providers even though up to 80% of patients with cancer develop malnutrition and poor nutrition has a profound impact on cancer treatment and survivorship. Only about half of US ambulatory oncology settings screen for malnutrition, registered dietitian nutritionists (RDNs) are not routinely employed by oncology clinics, and the medical nutrition therapy they provide is often not reimbursed. Thus, adequate nutrition care in US oncology clinics remains a gap area. Some oncology clinics are addressing this gap through implementation of nutrition-focused quality improvement programs (QIPs) but many are not. What is needed is a change of perspective. This paper outlines how and why quality nutrition care is integral to the OCM and can benefit patient health and provider outcomes.

scholarly journals A prospective cohort study of older colorectal cancer surgical patients: an association of post-operative clinical outcome with sarcopenia, frailty, and nutritional status [Protocol] (Preprint)

2019 ◽  
Author(s):  
Nia Humphry
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Nutritional Status ◽  
Significant Proportion ◽  
The Elderly ◽  
Operative Risk ◽  
Surgical Patients ◽  
Clinical Frailty Scale ◽  
Colorectal Cancer Surgery ◽  
Colorectal Cancer Resection

UNSTRUCTURED Older patients account for a significant proportion of patients undergoing colorectal cancer surgery, and are vulnerable to a number of pre-operative risk factors that are not often present in younger patients. Three pre-operative risk factors more prevalent in the elderly are frailty, sarcopenia, and malnutrition. Whilst each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. One particular area of increasing interest is the use of urine metabolomics for objective evaluation of dietary profiles and malnutrition. Herein we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. These procedures include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (with hand grip strength and 4-metre walk test), muscle mass evaluations using computerized tomography morphometric analysis and evaluation of nutritional status using analysis of urinary dietary biomarkers. As these are all areas of common derangement in the elderly surgical population, prospectively studying them in concert will allow for analysis of their interplay as well as the development of predictive models for those at risk for commonly tracked surgical complications and outcomes.

scholarly journals Modifications in anesthesia for geriatric patients

2016 ◽  
Vol 84 (2) ◽  
pp. 10-11
Author(s):  
Brandon Chau ◽  
Alexander Levit
Keyword(s):  
Daily Living ◽  
Patient Monitoring ◽  
Postoperative Delirium ◽  
Geriatric Patients ◽  
Postoperative Morbidity ◽  
Perioperative Period ◽  
The Elderly ◽  
Organ Function ◽  
Age Related ◽  
Geriatric Anesthesia

The volume of geriatric surgery is expected to increase dramatically by 2020, requiring a more widespread appreciation of the unique risks and challenges of anesthesia in the elderly. Changes in pharmacokinetics along with age-related changes in organ function have important implications for patient monitoring and dosing of anesthetic, analgesic, and sedative medications. Preoperative screening for risk of postoperative morbidity is improved with an assessment of activities of daily living, and regional anesthesia may be considered to reduce the risk of postoperative delirium, although this remains controversial. Specific homeostatic parameters should be closely monitored in the perioperative period. The approach to anesthesia in geriatric patients should not be merely extrapolated from younger patients, and further evidence specific to geriatric anesthesia will improve surgical outcomes.

Irritable Bowel Syndrome (IBS)

2021 ◽  
pp. 182-201
Author(s):  
Eram Albajri ◽  
Manal Naseeb
Keyword(s):  
Irritable Bowel Syndrome ◽  
Monitoring And Evaluation ◽  
Nutrition Therapy ◽  
Care Plan ◽  
Medical Nutrition Therapy ◽  
Self Awareness ◽  
Dietary History ◽  
Nutrition Care ◽  
Irritable Bowel ◽  
Medical Nutrition

The proposed case will discuss irritable bowel syndrome. Individualized medical nutrition therapy is critical in the disease management. In this case, the learner will be provided with details to conceptualize the case and will be able to conduct a comprehensive nutrition assessment to evaluate the nutritional status. After identifying and prioritizing nutrition problems, the learner will determine the nutrition diagnoses and write proper statements. Based on the collected data, the learner will develop a nutrition care plan with appropriate goals, interventions, and strategies for monitoring and evaluation. Unspecified-IBS encounter challenges with food as it triggers the symptoms. Thus, the learner will evaluate the nutrient composition of dietary history and provide a substitute considering individual tolerance and severity of the symptoms. In addition, FODMAP will be applied. It also teaches patients what foods or eating patterns would be best (or best to avoid) for their day-to-day activities through self-awareness of symptoms and dietary food log.

Nutrition

2019 ◽  
pp. 188-196
Author(s):  
George W. Williams
Keyword(s):  
Infectious Disease ◽  
Wound Healing ◽  
Critical Care ◽  
Nutritional Status ◽  
Respiratory Function ◽  
Surgical Patients ◽  
Nutritional Management ◽  
Equal Degree ◽  
Perioperative Nutrition

Nutrition is the second of two principal concepts (the first being infectious disease) in critical care not heavily emphasized in core anesthesiology training for reasons that are obvious. Optimal nutritional management is imperative to achieve positive outcomes in surgical patients. Wound healing, mobilization, and respiratory function are all particularly affected by nutritional status, and the optimal application assessment of nutrition directly affects surgical patients in the long term. Clinically, many physicians may take nutrition for granted and potentially conclude that it is not acutely important. Following consuming this content, the reader will be better equipped to educate their colleagues on the optimal assessment and application of perioperative nutrition. This chapter provides clinically useful and examination-oriented substrate to an equal degree, while being optimally digestible by the reader (no pun intended).

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