Deftereos Irene, Yeung Justin M C, Arslan Janan, Carter Vanessa M, Isenring Elizabeth, Kiss Nicole
Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC, Australia.
Department of Nutrition and Dietetics, Western Health, Footscray, VIC, Australia.
J Hum Nutr Diet. 2023 Apr;36(2):468-478. doi: 10.1111/jhn.13006. Epub 2022 Apr 11.
The present study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, as well as the use of evidence-based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes.
Principal investigator dietitians for the sites (n = 27) participating in the NOURISH point prevalence study participated in a purpose-built site-specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day 1 post surgery, length of stay, and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol.
The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty-five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, as well as higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions, and European Society of Clinical Nutrition and Metabolism (ESPEN) guideline compliant care day 1 post surgery.
The results of the present study demonstrate varied perioperative outpatient nutrition services in this high-risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes.
本研究旨在调查澳大利亚为接受上消化道癌手术患者提供护理的机构的健康服务营养实践，包括围手术期营养支持服务和门诊诊所的提供情况，以及基于证据的营养护理路径/方案的使用情况。次要目的是调查营养护理路径/方案的使用与患者结局之间的关联。
参与“营养支持改善结局与减少并发症（NOURISH）”现况调查研究的机构（n = 27）的主要研究者营养师参与了一项专门针对特定机构的围手术期营养实践和方案的调查。使用多变量分析对参与研究的200名患者的数据（包括营养不良患病率、术前体重减轻和接受营养干预情况、术中插入喂养管情况、术后第1天提供营养支持情况、住院时间和并发症）进行调查，以确定与机构使用营养护理路径/方案之间的关联。
大多数机构（>92%）报告在化疗/放疗中有营养服务。85%的机构报告有某种形式的门诊服务；然而，术前仅有26%的机构提供常规服务，术后为37%。大多数术前服务纳入了外科/肿瘤诊所（70%）；然而，术后诊所中只有44%报告了这一情况。只有44%的机构制定了营养护理路径/方案。使用营养护理路径/方案与较低的营养不良发生率相关，同时术前营养干预率、术中插入喂养管率以及术后第1天符合欧洲临床营养与代谢学会（ESPEN）指南的护理率较高。
本研究结果表明，在这一高风险患者群体中，围手术期门诊营养服务存在差异。营养护理路径和方案的使用与改善患者结局相关。
