Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia.
Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia.
Nutrients. 2021 Sep 15;13(9):3205. doi: 10.3390/nu13093205.
Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated.
The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded.
Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries ( < 0.001 and = 0.029, respectively). Neoadjuvant therapy ( = 0.003) and malnutrition ( = 0.046) remained independently associated with receiving dietetics intervention; however, 31.3% of malnourished patients had not seen a dietitian. Patients who received ≥3 dietetics appointments had lower mean (SD) percentage weight loss at the 1-month preoperative timeframe compared with patients who received 0-2 appointments (1.2 (2.0) vs. 3.1 (3.3), = 0.001). Patients who received ONS for >2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient -7.3, 95% CI -14.3, -0.3, = 0.04).
Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence-practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support.
在上消化道（UGI）癌症切除术前推荐进行术前营养干预；然而，目前对于临床实践中接受的干预措施的了解有限。本研究调查了接受的术前饮食干预和营养支持的类型和频率，以及与干预措施相关的临床和人口统计学因素。还调查了干预与术前体重减轻、手术住院时间（LOS）和并发症之间的关系。
NOURISH 点患病率研究于 2019 年 9 月至 2020 年 5 月在澳大利亚 27 个三级中心进行。入院后 7 天内进行主观全面评估和体重测量。患者报告术前饮食和营养干预情况，记录手术 LOS 和并发症。
共有 200 名患者参与（59%为男性，平均（标准差）年龄 67（10）岁）。60%的患者术前看过营养师，50%的患者接受营养支持（92%口服营养支持（ONS））。接受胰腺手术的患者接受饮食干预和营养支持的可能性低于食管或胃手术患者（<0.001 和=0.029）。新辅助治疗（=0.003）和营养不良（=0.046）仍然与接受饮食干预独立相关；然而，31.3%的营养不良患者没有看过营养师。接受≥3 次饮食咨询的患者在术前 1 个月的体重百分比丢失平均值（SD）低于接受 0-2 次咨询的患者（1.2（2.0）比 3.1（3.3），=0.001）。接受 ONS >2 周的患者体重百分比丢失平均值（SD）低于未接受 ONS 的患者（1.2（1.8）比 2.9（3.4），=0.001）。在营养不良的患者中，饮食咨询次数≥3 次与减少手术并发症独立相关（优势比 0.2，95%置信区间（CI）0.1，0.9，=0.04），而 ONS >2 周与减少 LOS 相关（回归系数-7.3，95%CI-14.3，-0.3，=0.04）。
尽管有建议，但该人群中术前饮食咨询和营养支持的比例较低，这与术前体重减轻增加以及营养不良患者 LOS 和并发症风险增加有关。本研究的结果提供了改善证据实践差距的见解，并为术前营养支持的最佳方法提供了数据支持，以供进一步研究。
