Annals of Clinical Nutrition and Metabolism

Perioperative nutritional practice of surgeons in Korea: a survey study: Ji-Hyeon Park, Mi Ran Jung, Sang Hyun Kim, Hongbeom Kim, Gyeongsil Lee, Jae-Seok Min, Heung-Kwon Oh, Jung Hoon Bae, Yoona Chung, Dong-Seok Han, Seung Wan Ryu, The External Relation Committee of the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2024;16(3):134-148. Published online December 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.3.134

Abstract PDF Supplementary Material: Purpose: Enhanced recovery after surgery (ERAS) protocols advocate reduced fasting and early nutrition to improve recovery in surgical patients. However, data on ERAS implementation among Korean surgeons performing major abdominal surgeries remain sparse.
Methods: A survey conducted by the External Relation Committee of the Korean Society of Surgical Metabolism and Nutrition assessed perioperative nutritional practices among 389 Korean general surgeons from February to September 2023. The survey covered preoperative fasting, carbohydrate drinks, nasogastric tube use, postoperative dietary progression, parenteral nutrition (PN), and oral supplements, yielding 551 responses stratified by specialty.
Results: More than 80% of respondents practiced “midnight NPO (Nil Per Os)” fasting, often at the anesthesiology department’s request, while 70%–80% reported no use of preoperative carbohydrate drinks. Most surgeons began dietary progression with water on postoperative day one, advancing to a liquid or soft diet by day two. PN was routinely prescribed by 49% of respondents, with a common dosage of 1,000–1,500 kcal/d. Oral supplements were selectively provided, with 21% of surgeons prescribing them universally.
Conclusion: The results reveal significant variability in perioperative nutrition practices across Korean surgical specialties, with many adhering to traditional practices despite ERAS guidelines. These findings highlight a need for standardized guidelines in Korea to optimize perioperative nutritional support and improve patient recovery outcomes following major abdominal surgeries.

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The 2024 Korean Enhanced Recovery After Surgery guidelines for colorectal cancer: Kil-yong Lee, Soo Young Lee, Miyoung Choi, Moonjin Kim, Ji Hong Kim, Ju Myung Song, Seung Yoon Yang, In Jun Yang, Moon Suk Choi, Seung Rim Han, Eon Chul Han, Sang Hyun Hong, Do Joong Park, Sang-Jae Park, The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition; Ann Clin Nutr Metab 2024;16(2):22-42. Published online August 1, 2024; DOI: https://doi.org/10.15747/ACNM.2024.16.2.22

Abstract PDF Supplementary Material: The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition was established to develop ERAS guidelines tailored to the Korean context. This guideline focuses on creating the most current evidence-based practice guidelines for ERAS based on systematic reviews. All key questions targeted randomized controlled trials (RCTs) exclusively. If fewer than two RCTs were available, studies using propensity score matching were also included. Recommendations for each key question were marked with strength of recommendation and level of evidence following internal and external review processes by the committee.

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Survey and Analysis of the Application and Implementations of Enhanced Recovery after Surgery (ERAS) Program for Surgical Patients in the Major Hospitals in Korea: Eun Young Kim, In Kyu Lee; Surg Metab Nutr 2019;10(2):32-45. Published online December 30, 2019; DOI: https://doi.org/10.18858/smn.2019.10.2.32

Abstract PDF: Purpose:

A questionnaire survey was conducted using e-mail to investigate the application status of ERAS in Korea and its implementation by their institution. The perceptions of ERAS by medical staff and the factors that interfered with the application of ERAS were investigated.

Materials and Methods:

From July 2017 to March 2019, a questionnaire was sent by e-mail to members of the KSSMN. This consisted of 41 questions divided into three parts to investigate 1) respondents’ prior knowledge and understanding of ERAS, 2) actual components of ERAS and its clinical application, and 3) performance and preference of the respondents to ERAS. The items were categorized into “high acceptance” when more than 75% of respondents answered “yes”, or the items into “low acceptance” when less than 25% answered “no”.

Results:

Overall, 86 participants completed the survey. Of these, 59(68.6%) had prior knowledge of ERAS and 29 (33.7%) applied ERAS clinically. Seventy (81.4%) and 40 (46.5%) answered that ERAS would have a positive effect on shortening the hospital stay and reducing the number of complications. Seventy four (86%) indicated that they would implement ERAS in the future. The factors impeding the implementation of ERAS were a lack of understanding of physicians and a shortage of manpower and resources for ERAS.

Conclusion:

The ERAS implementation rate and awareness level of surgeons were low, but the positive expectations of the clinical efficacy of ERAS and the wiliness to accept were high. Overall, it would be necessary to cooperate with institutions to improve the manpower and resources, and supplement the education to overcome the lack of awareness, which has been pointed out as an obstacle to the implementation of ERAS.

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Pilot Study for Safety and Efficacy of Newly Developed Oral Carbohydrate-Rich Solution Administration in Adult Surgery Patients: Won-Bae Chang, Kyuwhan Jung, Sang-Hoon Ahn, Heung-Gwon Oh, Mi-Ok Yoon; J Clin Nutr 2016;8(1):24-28. Published online April 30, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.1.24

Abstract PDF: Purpose:
In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients.
Methods:
A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables.
Results:
No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4.
Conclusion:
Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.

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Enhanced Recovery After Surgery is Feasible in Laparoscopic Low Anterior Resection for Rectal Cancer: Jeong Seon Jo, Soo Young Lee, Hun Jin Kim, Chang Hyun Kim, Young Jin Kim, Hyeong Rok Kim; Surg Metab Nutr 2015;6(1):11-15. Published online June 30, 2015; DOI: https://doi.org/10.18858/smn.2015.6.1.11

Abstract PDF: Purpose:
The aim of this study was to compare short-term outcomes in patients who underwent laparoscopic assisted low anterior resection for colorectal cancer. The patients received either conventional perioperative care or the Enhanced Recovery After Surgery (ERAS) procedural care.
Materials and Methods:
A retrospective review was conducted in patients who underwent elective laparoscopic low anterior resection for colorectal cancer between May, 2011 and December, 2013. Patients were grouped and analyzed according to the perioperative care program of ERAS and conventional care.
Results:
A total of 81 patients received care via the ERAS pathway and 230 patients received care via conventional pathway. There was no significant difference in postoperative morbidity rates (P=0.381). The post-operative morbidity rates were 30.9% and 25.2% in the ERAS and conventional groups. No significant difference in hospital stay (9.0±6.8 vs. 8.6±3.5 days; P=0.575) was observed between the 2 groups.
Conclusion:
No short-term perioperative disadvantages were found for the ERAS program compared with the conventional perioperative care for colorectal cancer patients who underwent laparoscopic low anterior resection. (Surg Metab Nutr 2015;6:11-15)

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