Zhigang Xue, MD, Jianchun Yu, MD, Weiming Kang, MD, Zhiqiang Ma, MD, PhD, Xin Ye, MD, Yuguang Huang, MD, Lijian Pei, MD. Peking Union Medical College Hospital, Chinese Academy of Medical Sciences
Aim: Enhanced recovery after surgery (ERAS) program focusing on nutritional risk assessment and comprehensive perioperative nutritional intervention is limited. We aimed to study the safety and efficacy of ERAS program focusing on the integrative clinical nutrition concept.
Methods: Our study was a single-center, prospective cohort study. The ERAS group included special focus on preoperative nutritional assessment, nutritional supplements by oral or tube feeding, early postoperative enteral nutrition (EN), combined with other series of ERAS items including no routine mechanical bowel preparation, preoperative carbohydrate loading, NSAIDs as analgesic meditation, no routine of gastric tube, no routine or early removal of peritoneal drainage and so on. The control group was under traditional perioperative management including routine mechanical bowel preparation, preoperative fasting and fluids limitation for 6-8 hours prior to induction of anesthesia, opioid analgesia, routine placement of gastric tube and peritoneal drainage, postoperative parenteral nutrition (PN) and so on. The primary outcome was postoperative length of hospital stay (LOS), and secondary outcomes included total hospitalization cost, postoperative complication rate, readmission rate within postoperative 60 days.
Results: From December 2015 to April 2018, we enrolled 204 patients with GI surgery in the Department of General Surgery, Peking Union Medical College Hospital, and Chinese Academy of Medical Sciences. 102 patients in the ERAS process group, and 102 patients in the traditional process group. The postoperative LOS in the ERAS group was significantly lower than that in the traditional group (7.2±4.5 days vs. 9.8±4.8 days, p<0.001). Total hospitalization cost in the ERAS group was significantly lower than that in the traditional process group (41 125±18 593 RMB vs. 51 512±19 453 RMB, p<0.001) as well. The postoperative EN start time in ERAS group was on 2.4±1.8 days after surgery (POD), and the traditional group was on POD 5.1±1.2 (p<0.001). There was no significant difference in the incidence of postoperative complications between the two groups (ERAS group: 9.8% vs. traditional group 13.7%, p=0.646), and readmission rate within postoperative 60 days were 2.9% and 2.0% respectively.
Conclusion: Perioperative Nutrition-focused Intervention including preoperative nutritional assessment and intervention and early postoperative EN as well as other ERAS programs are safe and effective in GI surgery. Nutrition-enhanced ERAS program helps to reduce postoperative hospitalization and total cost significantly, while showing no increase of postoperative complications and readmission rate within POD 60. Integrative clinical nutrition-focused program may be more reasonable and feasible when achieving enhanced recovery after GI surgery.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93781
Program Number: P292
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster