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Perioperative Nutritional Status and Optimization for Patients

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (10 September 2021) | Viewed by 10027

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Special Issue Editor

Dr. Misha D. P. Luyer

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Guest Editor

Department of Surgery, Catharina Hospital, 5623 Eindhoven, The Netherlands
Interests: upper GI surgery; pancreatic surgery; nutrition; inflammation; minimally invasive surgery; enhanced recovery after surgery; robotic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Nutrition has gained a prominent role in postoperative recovery and has been embedded in clinical care pathways in various types of abdominal surgery. The beneficial effects of adequate preoperative nutritional assessment and the early postoperative initiation of nutrition on postoperative outcomes and the modulation of the surgical stress response are important driving factors.

Focus has shifted from the postoperative pathway to the identification of patients at risk for malnutrition and optimizing nutritional status as soon as possible in the preoperative phase. Although for some types of abdominal surgeries, such as colorectal surgery, these new nutritional strategies are increasingly being adopted in, for example, upper GI surgery, the exact role of nutrition has been a subject of discussion. In this Special Issue, submissions of manuscripts describing original research, reviews of the scientific literature, systematic reviews or meta-analyses are welcomed that elaborate on the role of perioperative nutritional optimization in surgical patients.

Dr. Misha D. P. Luyer
Guest Editor

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Keywords

Malnutrition
Surgery
Enhanced recovery after surgery
Prehabilitation
Complications

Published Papers (4 papers)

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Research

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10 pages, 280 KiB

Open AccessArticle

Risk Factors for Failure of Direct Oral Feeding Following a Totally Minimally Invasive Esophagectomy

by Henricus J. B. Janssen, Amaia Gantxegi, Laura F. C. Fransen, Grard A. P. Nieuwenhuijzen and Misha D. P. Luyer

Nutrients 2021, 13(10), 3616; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103616 - 15 Oct 2021

Cited by 2 | Viewed by 1593

Abstract

Recently, it has been shown that directly starting oral feeding (DOF) from postoperative day one (POD1) after a totally minimally invasive Ivor-Lewis esophagectomy (MIE-IL) can further improve postoperative outcomes. However, in some patients, tube feeding by a preemptively placed jejunostomy is necessary. This single-center cohort study investigated risk factors associated with failure of DOF in patients that underwent a MIE-IL between October 2015 and April 2021. A total of 165 patients underwent a MIE-IL, in which DOF was implemented in the enhanced recovery after surgery program. Of these, 70.3% (n = 116) successfully followed the nutritional protocol. In patients in which tube feeding was needed (29.7%; n = 49), female sex (compared to male) (OR 3.5 (95% CI 1.5–8.1)) and higher ASA scores (III + IV versus II) (OR 2.2 (95% CI 1.0–4.8)) were independently associated with failure of DOF for any cause. In case of failure, this was either due to a postoperative complication (n = 31, 18.8%) or insufficient caloric intake on POD5 (n = 18, 10.9%). In the subgroup of patients with complications, higher ASA scores (OR 2.8 (95% CI 1.2–6.8)) and histological subtypes (squamous-cell carcinoma versus adenocarcinoma and undifferentiated) (OR 5.2 (95% CI 1.8–15.1)) were identified as independent risk factors. In the subgroup of patients with insufficient caloric intake, female sex was identified as a risk factor (OR 5.8 (95% CI 2.0–16.8)). Jejunostomy-related complications occurred in 17 patients (10.3%). In patients with preoperative risk factors, preemptively placing a jejunostomy may be considered to ensure that nutritional goals are met. Full article

(This article belongs to the Special Issue Perioperative Nutritional Status and Optimization for Patients)

19 pages, 1816 KiB

Open AccessArticle

Feasibility and Efficiency of the BEFORE (Better Exercise and Food, Better Recovery) Prehabilitation Program

by Thaís T. T. Tweed, Misha A. T. Sier, Ad A. Van Bodegraven, Noémi C. Van Nie, Walther M. W. H. Sipers, Evert-Jan G. Boerma and Jan H. M. B. Stoot

Nutrients 2021, 13(10), 3493; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13103493 - 02 Oct 2021

Cited by 11 | Viewed by 2689

Abstract

Prehabilitation has been postulated as an effective preventive intervention to reduce postoperative complications, particularly for elderly patients with a relatively high risk of complications. To date, it remains to be determined whether prehabilitation increases physical capacity and reduces postoperative complications. The aim of this study was to assess the feasibility of a 4-week multimodal prehabilitation program consisting of a personalized, supervised training program and nutritional intervention with daily fresh protein-rich food for colorectal cancer patients aged over 64 years prior to surgery. The primary outcome was the feasibility of this prehabilitation program defined as ≥80% compliance with the exercise training program and nutritional intervention. The secondary outcomes were the organizational feasibility and acceptability of the prehabilitation program. A compliance rate of ≥80% to both the exercise and nutritional intervention was accomplished by 6 patients (66.7%). Attendance of ≥80% at all 12 training sessions was achieved by 7 patients (77.8%); all patients (100%) attended ≥80% of the available training sessions. Overall, compliance with the training was 91.7%. Six patients (66.7%) accomplished compliance of ≥80% with the nutritional program. The median protein intake was 1.2 (g/kg/d). No adverse events occurred. This multimodal prehabilitation program was feasible for the majority of patients. Full article

(This article belongs to the Special Issue Perioperative Nutritional Status and Optimization for Patients)

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9 pages, 969 KiB

Open AccessArticle

Association between Preoperative Long-Chain Polyunsaturated Fatty Acids and Oxidative Stress Immediately after Total Knee Arthroplasty: A Pilot Study

by Yusuke Kubo, Masae Ikeya, Shuhei Sugiyama, Rie Takachu, Maki Tanaka, Takeshi Sugiura, Kaori Kobori and Makoto Kobori

Nutrients 2021, 13(6), 2093; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13062093 - 19 Jun 2021

Cited by 5 | Viewed by 2349

Abstract

Quadriceps muscle atrophy following total knee arthroplasty (TKA) can be caused by tourniquet-induced ischemia–reperfusion (IR) injury, which is often accompanied by oxidative stress and inflammatory responses. n-3 long-chain polyunsaturated fatty acids (LCPUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), exert antioxidant and anti-inflammatory effects against IR injury, whereas n-6 LCPUFAs, particularly arachidonic acid (AA), exhibit pro-inflammatory effects and promote IR injury. This study aimed to examine whether preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio are associated with oxidative stress immediately after TKA. Fourteen eligible patients with knee osteoarthritis scheduled for unilateral TKA participated in this study. The levels of serum EPA, DHA, and AA were measured immediately before surgery. Derivatives of reactive oxygen metabolites (d-ROMs) were used as biomarkers for oxidative stress. The preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio were found to be significantly negatively correlated with the serum d-ROM levels at 96 h after surgery, and the rate of increase in serum d-ROM levels between baseline and 96 h postoperatively. This study suggested the preoperative serum EPA + DHA levels and the (EPA + DHA)/AA ratio can be negatively associated with oxidative stress immediately after TKA. Full article

(This article belongs to the Special Issue Perioperative Nutritional Status and Optimization for Patients)

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Review

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28 pages, 6219 KiB

Open AccessReview

Elective Surgery in Adult Patients with Excess Weight: Can Preoperative Dietary Interventions Improve Surgical Outcomes? A Systematic Review

by Sally B. Griffin, Michelle A. Palmer, Esben Strodl, Rainbow Lai, Matthew J. Burstow and Lynda J. Ross

Nutrients 2021, 13(11), 3775; https://0-doi-org.brum.beds.ac.uk/10.3390/nu13113775 - 25 Oct 2021

Cited by 7 | Viewed by 2842

Abstract

This systematic review summarises the literature regarding the impact of preoperative dietary interventions on non-bariatric surgery outcomes for patients with excess weight/obesity, a known risk factor for poor surgical outcomes. Four electronic databases were searched for non-bariatric surgery studies that evaluated the surgical outcomes of a preoperative diet that focused on weight/fat loss or improvement of liver steatosis. Meta-analysis was unfeasible due to the extreme heterogeneity of variables. Fourteen studies, including five randomised controlled trials, were selected. Laparoscopic cholecystectomy, hernia repair, and liver resection were most studied. Diet-induced weight loss ranged from 1.4 kg to 25 kg. Preoperative very low calorie diet (≤800 kcal) or low calorie diet (≤900 kcal) for one to three weeks resulted in: reduction in blood loss for two liver resection and one gastrectomy study (−27 to −411 mL, p < 0.05), and for laparoscopic cholecystectomy, reduction of six minutes in operating time (p < 0.05) and reduced difficulty of aspects of procedure (p < 0.05). There was no difference in length of stay (n = 7 studies). Preoperative ≤ 900 kcal diets for one to three weeks could improve surgical outcomes for laparoscopic cholecystectomy, liver resection, and gastrectomy. Multiple randomised controlled trials with common surgical outcomes are required to establish impact on other surgeries. Full article

(This article belongs to the Special Issue Perioperative Nutritional Status and Optimization for Patients)

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