Annals of Clinical Nutrition and Metabolism

Volume 11 (1); June 2020

Original Articles

Status of Nutritional Support after Emergency Gastrointestinal Surgery in Korea: Retrospective Multicenter Study: Dae Sang Lee, Young Eun Park, Kyoung Hoon Lim, Ye Rim Chang, Suk-Kyung Hong, Minchang Kang, Jung-Min Bae, Ji Young Jang, Young Goun Jo, Ki Hoon Kim, Gil Jae Lee; Surg Metab Nutr 2020;11(1):1-6. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.1

Abstract PDF: Purpose: Surgery itself causes an inflammatory response to an injury to the patient that leads to a stress metabolic state. Emergency gastrointestinal surgery may cause complications, such as ileus, bowel obstruction, ischemia, or anastomotic leakage, resulting in a delayed oral diet or poor overall nutrition. This study investigated the route of nutrition for patients who underwent emergency gastrointestinal surgery and when to provide nutrition after surgery.
Materials and Methods: Ten hospitals collected data retrospectively on the nutritional status and nutritional status of patients undergoing emergency gastrointestinal surgery for one year from January to December 2016. The clinical outcomes of the nutrient supply method, duration of supply, and type of surgery were performed. The dates from the time of surgery to the start of enteral nutrition, oral nutrition, and parenteral nutrition were calculated.
Results: Of 706 patients, there were 187 (26.5%) trauma patients, of which 63.5% were male. The onset of nutrition began after an average of 10.7 days postoperatively and after an average of 12.1 days of enteral nutrition. On average, it took 7.7 days to provide adequate calories, of which 63.3% had achieved adequate calories within a week. In the case of minimally invasive surgery, such as laparoscopic surgery, the adequate calorie supply time was five days, which was reached within one week.
Conclusion: In a retrospective multicenter analysis, the patients who underwent emergency gastrointestinal surgery had a late start of oral or enteral nutrition, and the ratio of adequate calorie supply within a week was low.

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Nutritional Support Team Approach Decreases the In-Hospital Mortality Rate after Deceased Donor Liver Transplantation: Sang-Oh Yun, Jong Man Kim, Sangjin Kim, Jinsoo Rhu, Hyun Jung Kim, Soo Hyun Park, Hyo Jung Park, Eunmi Gil, Wonseok Kang, Gyu-Seong Choi, Won Hyuck Chang, Jeong-Meen Seo, Jae-Won Joh; Surg Metab Nutr 2020;11(1):7-11. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.7

Abstract PDF: Purpose: This study compared the mortality rates between a period of time without employing a nutritional support team (NST) and a period of time with an NST.
Materials and Methods: Forty-six patients underwent adult deceased donor liver transplantation (DDLT) in 2016, and their medical records were prospectively collected. All the donor recipients underwent routine enteral feeding after liver transplantation. An NST cared for twenty-one patients after September 2016. The NST consisted of transplant surgeons, hepatologists, a critical care team, a rehabilitation team, dietitians, pharmacists, and nurses. We defined the patients within the time period without an NST as the control group and those patients within the time period with an NST as the case group.
Results: There were no statistically significant differences in baseline or perioperative characteristics between the two groups. The median model for the end-stage liver disease (MELD) score was 36 (range: 21∼40) for the control group and 36 (range: 23∼40) for the case group (P=0.596). The 30-day mortality rate was 24.0% (6/25) for the control group, but it was 4.8% (1/20) for the case group. The patient survival rates at 1-year and 2-year were 68.0% and 64.0% in the control group and 85.7% and 81.0% in the case group, respectively. However, there were no statistically significant differences of the 30-day mortality rate and 1∼2 year patient survival rate between the two groups.
Conclusion: The present study suggests that an NST should be required to prevent 30-day mortality and increase patient survival of adult DDLT patients with a high MELD score.

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Analysis of Muscle Using CT Anthropometry in Major Trauma Patients: Hang Joo Cho, Yunsup Hwang, Yoon Hyun Lee, Dae Hyun Cho, Dae-Sang Lee, Maru Kim; Surg Metab Nutr 2020;11(1):12-15. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.12

Abstract PDF: Purpose: The feasibility of nutritional assessment using computed tomography anthropometry has been previously proven. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, and especially sarcopenia. However, any studies on nutritional assessment of the brain, face, or neck via computed tomography are still scarce. We retrospectively investigated the applicability of the masseter muscle as a nutritional biomarker.
Materials and Methods: Patients who underwent simultaneous brain and abdominopelvic computed tomography at a regional trauma center were retrospectively analyzed. Their masseter muscles at 2 cm below the zygomatic arch and abdominal muscle at L3 were assessed via computed tomography anthropometry. Basic clinical data including trauma information was also reviewed. The data was analyzed in conjunction with the patients’ mortality.
Results: A total of 411 patients were analyzed in the study (316 men and 95 women, mean age: 50.41 years, mean areas of the masseter and abdominal muscles: 10.6 and 137.3 cm², respectively) and there 146 major trauma patients with an injury severity score higher than 15. The masseter muscle area was decreased in the mortality group of major trauma patients (10.4 vs 7.9 cm², P=0.001). However, abdominal muscles did not show statistical significance (137.9 vs. 117.7 cm², P=0.054).
Conclusion: The masseter muscle, when analyzed via computed tomography anthropometry, showed a statistical association with patients’ mortality and it could prove its feasibility as a nutritional biomarker.

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Analysis of the Factors Related to the Incidence and Aggravation of Pressure Ulcers for in Patients from a Nutritional and Clinical Perspective: Yoon Young Choi, Han Mo Yoo, Young Hwa Kim, Jeong Goo Kim; Surg Metab Nutr 2020;11(1):16-21. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.16

Abstract PDF: Purpose: The incidence of pressure ulcers has reached significant proportions in ward patients. Considering the increasing proportion of older patients, it is important to know the factors associated with pressure ulcers. The purpose of this study was to investigate the association between nutritional status patients and the prognosis of pressure ulcers.
Materials and Methods: Four hundred patients who had their nutritional status evaluated from December 2015 to May 2016 at Daejeon St. Mary’s Hospital were enrolled in this study. The Modified NRS 2002 was used to address the nutritional status. Pressure ulcers were evaluated using the PUSH score, and the nutritional factors were evaluated with pressure ulcer aggravation.
Results: Among the 400 patients who had their nutritional status evaluated, 174 (43.5%) had a pressure ulcer. A high risk of malnutrition was associated significantly with the incidence of pressure ulcers. In patients with pressure ulcers, the necessity of a nutritional support team approach (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.21∼4.91; P=0.01) and the number of pressure ulcers (odds ratio [OR], 3.79; 95% confidence interval [CI], 1.81∼7.91; P<0.001) were risk factors for pressure ulcer aggravation.
Conclusion: These results indicate that a proper evaluation of the malnutrition state and obtaining a nutritional support team intervention are important for preventing the aggravation of pressure ulcers. Furthermore, if a patient has multiple sites of pressure ulcers, a careful assessment will be needed to prevent their deterioration.

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The Utility of Open Gastrostomy Using Local Anesthesia and a Gastrostomy Tube for Percutaneous Endoscopic Gastrostomy: Jae Kyun Park, Chang In Choi, Dae Hwan Kim; Surg Metab Nutr 2020;11(1):22-26. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.22

Abstract PDF: Purpose: The purpose of this study is to introduce the technical details of open gastrostomy using local anesthesia and a gastrostomy tube for percutaneous endoscopic gastrostomy, and to evaluate the safety and utility of the procedure.
Materials and Methods: Between January 2011 and December 2015, a total of 46 patients who underwent open gastrostomy using local anesthesia and a gastrostomy tube for percutaneous endoscopic gastrostomy (open group, n=25) or laparoscopic gastrostomy (laparoscopy group, n=21) were enrolled in this retrospective study. We analyzed the clinical data and the perioperative data.
Results: There were no significant differences in the clinical characteristics of the two groups. However, the patients with a high anesthetic risk (American Society of Anesthesiologists [ASA] grade 3 or more) were significantly more prevalent in the open group than in the laparoscopic group (96.0% vs. 66.7%, respectively, P=0.013). The operation time (31.8±6.6 vs. 67.9±15.7 minutes, respectively, P<0.001) and the time to first tubal feeding (1.3±0.6 vs. 2.7±1.3 days, respectively, P<0.001) was significantly shorter in the open group than that in the laparoscopic group. Postoperative complications were more frequent in the laparoscopic group (4 cases, 19%) than that in the open group (1 case, 4%), but there was no statistically significant difference.
Conclusion: Open gastrostomy using local anesthesia and a gastrostomy tube for PEG is a safe and feasible method for treating patients with a high anesthetic risk.

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Risk Factors for Unexpected Removal of Peripherally Inserted Central Catheters and Proper Duration of the Catheter Maintenance: Narang Lee, Hyun-Dong Chae, In-Hwan Kim; Surg Metab Nutr 2020;11(1):27-33. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.27

Abstract PDF: Purpose: Despite the advantages of a peripherally inserted central catheter (PICC), many complications have led to the unexpected removal of catheters. On the other hand, there are no guidelines for the duration of PICC maintenance. This study analyzed the risk factors for the unexpected removal of PICC to suggest guidelines for the duration of catheter maintenance.
Materials and Methods: Among 520 patients who underwent PICC insertion from January 2014 to December 2015, 407 were included. Unexpected removal was observed in 95 patients. Univariate and multivariate analyses were performed to evaluate the risk factors for unexpected removal. The changing pattern of the probability of unexpected removal was analyzed by change point analysis.
Results: Malignancy (OR=4.498, 95% CI=2.49∼8.125) and ICU hospitalization (OR=4.218, 95% CI=1.694∼10.505) were significant risk factors for the unexpected removal of PICC. The left arm (OR=0.279, 95% CI=0.143∼0.544) and basilic vein (OR=0.323, 95% CI=0.192∼0.545) were associated with a lower probability of unexpected removal compared to the right arm and brachial vein, but selection bias could exist in the arm side and vein. Change-point analysis revealed a rapid increase in the probability of unexpected removal after 54 catheter days.
Conclusion: This study suggests the removal or exchange of PICC before 54 catheter days to minimize serious complications. More attention is needed for patients with malignancies and ICU stays.

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