• Support Care Cancer · Jun 2018

    An investigation into the nutritional status of patients receiving an Enhanced Recovery After Surgery (ERAS) protocol versus standard care following Oesophagectomy.

    • Katie Benton, Iain Thomson, Elisabeth Isenring, Mark Smithers B B Discipline of Surgery, Upper GI and Soft Tissue Unit, Princess Alexandra Hospital, University of Queensland, Ipswich Rd, Woolloongabba, Queensland, Aust, and Ekta Agarwal.
    • Department of Nutrition and Dietetics, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, Queensland, 4102, Australia. Katie.Benton@health.qld.gov.au.
    • Support Care Cancer. 2018 Jun 1; 26 (6): 2057-2062.

    PurposeEnhanced Recovery After Surgery (ERAS) protocols have been effectively expanded to various surgical specialities including oesophagectomy. Despite nutrition being a key component, actual nutrition outcomes and specific guidelines are lacking. This cohort comparison study aims to compare nutritional status and adherence during implementation of a standardised post-operative nutritional support protocol, as part of ERAS, compared to those who received usual care.MethodsTwo groups of patients undergoing resection of oesophageal cancer were studied. Group 1 (n = 17) underwent oesophagectomy between Oct 2014 and Nov 2016 during implementation of an ERAS protocol. Patients in group 2 (n = 16) underwent oesophagectomy between Jan 2011 and Dec 2012 prior to the implementation of ERAS. Demographic, nutritional status, dietary intake and adherence data were collected. Ordinal data was analysed using independent t tests, and categorical data using chi-square tests.ResultsThere was no significant difference in nutrition status, dietary intake or length of stay following implementation of an ERAS protocol. Malnutrition remained prevalent in both groups at day 42 post surgery (n = 10, 83% usual care; and n = 9, 60% ERAS). A significant difference was demonstrated in adherence with earlier initiation of oral free fluids (p <0.008), transition to soft diet (p <0.004) and continuation of jejunostomy feeds on discharge (p <0.000) for the ERAS group.ConclusionA standardised post-operative nutrition protocol, within an ERAS framework, results in earlier transition to oral intake; however, malnutrition remains prevalent post surgery. Further large-scale studies are warranted to examine individualised decision-making regarding nutrition support within an ERAS protocol.

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