Department of Anesthesiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
USF Health Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
Nutr Clin Pract. 2022 Feb;37(1):176-182. doi: 10.1002/ncp.10661. Epub 2021 Apr 26.
Preoperative malnourishment has been consistently associated with poor outcomes after radical cystectomy and other major abdominal surgeries. Most enhanced recovery after surgery (ERAS) studies have examined preoperative nutrition and its relationship to outcomes after gastrointestinal surgery. Although numerous studies have demonstrated the benefits of using an ERAS protocol, this study in unique in comparing 2 ERAS protocols, with and without a nutrition component.
A formalized preoperative nutrition protocol (PNP) recommending use of preoperative immunonutrition and carbohydrate drink was introduced in June 2018. A total of 78 consecutive patients who drank both beverages were compared with 92 historical controls. Multivariable logistic regression analyses were sequentially performed to determine if preoperative nutrition was associated with binary outcome variables (30-day complication, infectious complication, and readmission within 30 days).
The preoperative nutrition group and control group were statistically similar in distribution of age, sex, American Society of Anesthesiologists physical status classification, clinical stage, and body mass index. Return of bowel function was found to occur earlier in the preoperative nutrition group than in the control group (3.12 vs 3.74 days; relative risk, 0.82; CI, 0.73-0.93; P = .0029). Complications within 30 days were similar in both groups (63.6% vs 55.4%; P = 0.36). Infectious complications (42.9% vs 37%; P = .53) and readmission within 30 days (22.1% vs 15.2%; P = .34) were also similar in both groups.
Use of a PNP including immunonutrition and carbohydrate drink may be associated with earlier return of bowel function after radical cystectomy.
术前营养不良与根治性膀胱切除术和其他大型腹部手术后的不良结局密切相关。大多数术后加速康复（ERAS）研究都检查了胃肠道手术后的术前营养及其与结局的关系。尽管许多研究已经证明了使用 ERAS 方案的好处，但这项研究在比较两个 ERAS 方案，包括和不包括营养成分方面是独特的。
2018 年 6 月，引入了正式的术前营养方案（PNP），建议使用术前免疫营养和碳水化合物饮料。将饮用这两种饮料的 78 例连续患者与 92 例历史对照进行比较。连续进行多变量逻辑回归分析，以确定术前营养是否与二元结局变量（30 天并发症、感染性并发症和 30 天内再入院）相关。
术前营养组和对照组在年龄、性别、美国麻醉医师协会身体状况分类、临床分期和体重指数的分布上统计学上相似。术前营养组的肠功能恢复时间早于对照组（3.12 天 vs 3.74 天；相对风险，0.82；CI，0.73-0.93；P =.0029）。两组在 30 天内的并发症相似（63.6% vs 55.4%；P =.36）。两组的感染性并发症（42.9% vs 37%；P =.53）和 30 天内再入院率（22.1% vs 15.2%；P =.34）也相似。
使用包括免疫营养和碳水化合物饮料的 PNP 可能与根治性膀胱切除术后肠功能恢复较早有关。
