Postoperative early enteral nutrition or early oral ingestion is recommended in surgical patients. In this situation, this study examined the role of parenteral nutrition in the postoperative period in patients undergoing elective surgery. The nutritional status should be assessed before surgery and in the case of malnutrition, nutritional support should be provided before surgery to obtain good results. More than 2 weeks of insufficient nutritional support after surgery may worsen the patient’s progress. Therefore, it is recommended to start nutritional care if the oral intake is not appropriate until 7 days or 5 to 7 days after surgery. Enteral nutrition is related to the quick restoration of the bowel function and reduction of infection-related complications. Therefore, enteral nutrition has priority. On the other hand, depending on the patient’s condition, it may not be possible to perform enteral nutrition, and the uniform implementation of the early enteral nutrition may be a burden to the patient. Parenteral nutrition has the advantage that it can supply nutrition without being affected by the intestinal condition, and it can be calculated to supply as much energy as required. The situation, where parenteral nutrition is required after elective surgery, could be summarized as 1) the patients who underwent nutritional therapy before surgery and could not tolerate oral intake or enteral nutrition after surgery. or 2) in the case where enteral nutrition did not satisfy 50% of the demand at 7 days after surgery, and it is judged that this situation should continue for 7 days.
Enteral feeding is strongly recommended for critically ill patients since it can enhance the immunologic function, which serves as a host defense mechanism against inflammation or metabolic response to stress. Herein, we investigated nutritional status and estimated the adequacy of the nutritional supply for acutely ill patients admitted to the surgical intensive care unit (SICU) after a major operation.
From February to October 2016, patients admitted and stayed over 48 hours after major surgical procedures at SICU in Seoul St. Mary’s Hospital were reviewed. The nutritional parameters and surgical outcomes were compared according to the status of nutritional support.
A total of 220 patients composed of 130 males (59.1%) and 90 females (40.9%) were enrolled, and mean age was 61.4±13.6 years. All patients were classified into two groups according to nutritional status, which was assessed by the ratio of total delivered calories to total required calories (D/R); group A (54 cases, 24.5%, D/R≥0.7) versus group B (166 cases, 75.5%, D/R<0.7). In multivariate analysis, incision in the lower abdomen (Odds Ratio 2.277, P=0.078), absence of NST consultation (Odds Ratio 2.728, P=0.011), and not receive minimal invasive surgery (Odds Ratio 3.518, P=0.001) were independent risk factors associated with poor nutritional status.
Clinicians should pay more attention to patients who had an incision in the lower abdomen or did not receive minimal invasive surgery or NST consultation, which would be predisposing factors for nutritional insufficiency resulting in postoperative morbidities.