Annals of Clinical Nutrition and Metabolism

Review

Bedside support for neurologically impaired patients via nutritional evaluations, swallowing function assessments, and gastrointestinal function tests: a narrative review: Daisuke Masui, Naoki Hashizume, Yoshinori Koga, Hiroto Eto, Hiroki Yoshida, Shotaro Taki, Takato Aikoh, Shiori Tsuruhisa, Tomohiro Kurahachi, Naruki Higashidate, Tatsuru Kaji; Ann Clin Nutr Metab 2026;18(1):10-17. Published online March 30, 2026; DOI: https://doi.org/10.15747/ACNM.25.0018

Abstract PDF: Purpose
Neurologically impaired patients often experience complex challenges in respiratory and nutritional management that may necessitate surgical intervention. Furthermore, some patients admitted to specialized facilities for neurologically impaired individuals do not receive adequate postoperative follow-up after being transferred. Kurume University Hospital has established a system of continuous routine rounds at such facilities. This review aims to describe the rationale, methods, and outcomes of multidisciplinary bedside support, with particular emphasis on nutritional evaluation, swallowing function assessment, and gastrointestinal function testing.
Current concept
Routine collaboration between pediatric surgeons and facility-based pediatricians enables continuous perioperative management. Preoperatively, patient background, nutritional status, and family preferences are recorded through structured communication and shared decision-making tools, such as the Ottawa Personal Decision Guide. During hospitalization, multidisciplinary evaluations include bioelectrical impedance analysis for nutritional assessment, endoscopic and pH impedance testing for swallowing function, and multichannel intraluminal impedance monitoring for gastroesophageal reflux. Postoperatively, periodic facility rounds ensure ongoing evaluation, with repeated assessments guiding nutritional optimization, early complication detection, and timely surgical consultation. This approach provides families and healthcare teams with detailed information on functional outcomes, strengthens trust, and enhances continuity of care. Sustained bedside engagement at facilities for neurologically impaired patients improves pre- and postoperative monitoring, promotes seamless collaboration between institutions, and ensures individualized evaluation of nutrition, swallowing, and gastrointestinal function.
Conclusion
By providing actionable data to families and multidisciplinary teams, this model strengthens shared decision-making and supports long-term outcomes. The system may serve as a framework for integrated perioperative care in similar high-risk patient populations.

176 View
9 Download

Guideline

The 2024 Korean Enhanced Recovery After Surgery guidelines for hepatobiliary and pancreatic surgery: Kwangpyo Hong, Hongbeom Kim, Hyung Sun Kim, Hae Won Lee, Ho Joong Choi, YoungRok Choi, Jae Do Yang, Sung-Moon Jeong, Dae Wook Hwang, 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 2025;17(3):172-180. Published online December 1, 2025; DOI: https://doi.org/10.15747/ACNM.25.0034

Purpose
The Korean Enhanced Recovery After Surgery (ERAS) Committee within the Korean Society of Surgical Metabolism and Nutrition has developed comprehensive guidelines for hepatobiliary and pancreatic (HBP) surgery by adapting established international protocols. These guidelines provide evidence-based recommendations specifically tailored to the Korean healthcare system and address perioperative management for both pancreatoduodenectomy and hepatectomy.
Methods
The HBP subcommittee reviewed existing international ERAS guidelines and conducted an adaptation process. Key questions were identified based on national survey results from Korean HBP surgeons and were prioritized according to clinical relevance. The committee focused on elements supported by moderate- to high-quality evidence with strong recommendation grades. Literature searches were conducted through January 2025, and evidence quality was evaluated using GRADE methodology. Four key questions underwent formal assessment, and eight additional questions were adapted from international guidelines.
Results
Twelve key questions were selected and addressed, covering critical perioperative care domains: prehabilitation, preoperative nutritional assessment and support, anti-thrombotic prophylaxis, prophylactic abdominal drainage, preoperative biliary drainage, smoking and alcohol cessation, pre-anesthetic medication, minimally invasive surgical approaches, prophylactic nasogastric intubation, postoperative glycemic control, perianastomotic drainage management, and early mobilization protocols. Each recommendation was assigned specific evidence levels and graded for strength. High-quality evidence supported strong recommendations for the routine avoidance of prophylactic drainage in uncomplicated hepatectomy, early drain removal after pancreatoduodenectomy in low-risk patients, elimination of routine nasogastric decompression, and the implementation of early mobilization strategies.
Conclusion
These Korean-adapted ERAS guidelines for HBP surgery are expected to standardize perioperative care, reduce postoperative complications, shorten hospital stays, and enhance overall patient outcomes across Korean healthcare institutions.

Citations

Citations to this article as recorded by

Adapting Enhanced Recovery After Surgery for hepatobiliary and pancreatic surgery: a Korean perspective
Sang Hyun Shin
Ann Clin Nutr Metab.2026; 18(1): 1. CrossRef

2,268 View
61 Download
1 Crossref

Review Article

Perioperative Nutritional Support: Seung Jong Oh; J Clin Nutr 2021;13(1):7-11. Published online June 30, 2021; DOI: https://doi.org/10.15747/jcn.2021.13.1.7

Abstract PDF: Malnutrition in surgical patients is a prevalent problem. As the geriatric population gradually increases, surgeons need to be more careful in preventing the risk of iatrogenic malnutrition. Delayed wound healing, exposure to infection, pressure sores, gastrointestinal bacterial overgrowth, and immunosuppression in malnourished patients can be prevented or diminished with active nutritional support. Preoperative nutritional assessment and support, as well as adequate postoperative nutrition, will improve surgical outcomes, which in turn will lead to fewer postoperative complications, shorter hospital stays, and lower medical costs. The success of surgery depends not only on technical surgical skills but also on metabolic interventions that take into account the patient’s ability to deliver the metabolic load and provide adequate nutritional support.

1,113 View
6 Download

First
Prev
Page of 1
Next
Last

Search