Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
Eur J Clin Nutr. 2011 May;65(5):642-7. doi: 10.1038/ejcn.2011.13. Epub 2011 Feb 23.
BACKGROUND/OBJECTIVES: There is strong evidence for the beneficial effects of perioperative nutrition in patients undergoing major surgery. We aimed to evaluate implementation of current guidelines in Switzerland and Austria.
SUBJECTS/METHODS: A survey was conducted in 173 Swiss and Austrian surgical departments. We inquired about nutritional screening, perioperative nutrition and estimated clinical significance.
The overall response rate was 55%, having 69% (54/78) responders in Switzerland and 44% (42/95) in Austria. Most centres were aware of reduced complications (80%) and shorter hospital stay (59%). However, only 20% of them implemented routine nutritional screening. Non-compliance was because of financial (49%) and logistic restrictions (33%). Screening was mainly performed in the outpatient's clinic (52%) or during admission (54%). The nutritional risk score was applied by 14% only; instead, various clinical (78%) and laboratory parameters (56%) were used. Indication for perioperative nutrition was based on preoperative screening in 49%. Although 23% used preoperative nutrition, 68% applied nutritional support pre- and postoperatively. Preoperative nutritional treatment ranged from 3 days (33%), to 5 (31%) and even 7 days (20%).
Although malnutrition is a well-recognised risk factor for poor post-operative outcome, surgeons remain reluctant to implement routine screening and nutritional support according to evidence-based guidelines.
背景/目的：有强有力的证据表明，围手术期营养对接受大手术的患者有益。我们旨在评估瑞士和奥地利目前指南的实施情况。
受试者/方法：对 173 家瑞士和奥地利外科部门进行了一项调查。我们询问了营养筛查、围手术期营养和估计的临床意义。
总体回复率为 55%，瑞士有 69%（54/78）的回应者，奥地利有 44%（42/95）的回应者。大多数中心都意识到并发症减少（80%）和住院时间缩短（59%）。然而，只有 20%的中心实施了常规营养筛查。不遵守的原因是财务（49%）和后勤限制（33%）。筛查主要在门诊（52%）或住院期间进行（54%）。只有 14%的中心应用营养风险评分；相反，各种临床（78%）和实验室参数（56%）被使用。围手术期营养的指征基于术前筛查，占 49%。尽管 23%的中心使用术前营养，但 68%的中心在术前和术后都进行营养支持。术前营养治疗的时间范围为 3 天（33%）、5 天（31%）甚至 7 天（20%）。
尽管营养不良是术后不良结局的一个公认的危险因素，但外科医生仍然不愿意根据循证指南常规进行筛查和营养支持。
