Special Issue "The Role of Perioperative Nutrition Support in Postoperative Recovery"

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

Deadline for manuscript submissions: closed (25 November 2021).

Special Issue Editor

Dr. Antonio Arroyo Sebastián
E-Mail Website
Guest Editor
Head of General and Digestive Surgery Service. Elche University General Hospital. Professor of Surgery. Deputy Director of the Department of Pathology and Surgery. UMH School of Medicine
Interests: colorectal disease; obesity surgery; colon cancer; perioperative immunonutrition; nutritional intervention; cancer surgery

Special Issue Information

Dear colleagues,

Malnutrition is closely related to disease and aging, leading to a significant increase in postoperative complications, hospital stay, and readmission rates.

Therefore, rectification is essential to improve the results of surgery. Questions about supplementary nutrition, such as “for how long?”, “before, during, and/or after surgery?”, “enteral or parenteral?” “immunonutrition—yes or no?” are still being debated, with resolution open to considerations based on future evidence.

On the other hand, nutrition in the surgical patient has gained momentum within the ERAS (enhanced recovery surgery) programs where we are “obliged” to carry out nutritional screening of all surgical patients and, consequently, treat potential malnutrition.

Within the ERAS programs, the concept of “trimodal prehabilitation” has recently emerged, where the patient prepares for surgery through physical exercise and nutritional and psychological support. As part of these preparations, the implementation of oral enteral nutrition is proposed, even in a normally nourished patient to enhance the results of physical exercise and to correct states of protein malnutrition or sarcopenia in patients theoretically labeled as normally nourished in nutritional screening, anthropometric tests, lab work, and mass indices for normal bodies. That is why we must also propose new diagnostic methods and reliable measurements that are readily accessible to rule out sarcopenia.

With this Special Issue, we would like to present, to readers, the state-of-the-art in the field of perioperative nutrition support in postoperative recovery. Original research articles and reviews (systematic reviews and meta-analyses) are welcome.

Dr. Antonio Arroyo Sebastián
Guest Editors

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Keywords

  • diagnostic methods of sarcopenia
  • immunonutrition
  • parenteral nutrition
  • enteral nutrition
  • prehabilitation
  • enhanced recovery surgery
  • sarcopenia
  • nutritional screening

Published Papers (6 papers)

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Research

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Article
Assessment of Body Composition as an Indicator of Early Peripheral Parenteral Nutrition Therapy in Patients Undergoing Colorectal Cancer Surgery in an Enhanced Recovery Program
Nutrients 2021, 13(9), 3245; https://doi.org/10.3390/nu13093245 - 18 Sep 2021
Viewed by 776
Abstract
Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced [...] Read more.
Background: A poor body composition (BC) has been identified as a risk factor for patients with colorectal cancer (CRC). This study was performed to assess the effect of early peripheral parenteral nutrition (PPN) on BC in patients undergoing CCR surgery within an enhanced recovery program. Methods: Patients with normal nutritional status were prospectively included between October 2016 and September 2019, randomized into two groups (PPN with periOlimel N4-E versus conventional fluid therapy) and subsequently classified according to their preoperative CT scan into high- or low-risk BC groups. Postoperative complications and length of hospital stay (LOS) were assessed. Results: Of the 156 patients analyzed, 88 patients (56.4%) were classified as having high-risk BC according to CT measurements. PPN led to a 15.4% reduction in postoperative complications in high-risk vs. 1.7% in low-risk BC patients. In the multivariate analysis, high-risk BC was related to an OR (95% CI) of 2 (p = 0.044) of presenting complications and of 1.9 (p = 0.066) for major complications, and was associated with an increase in LOS of 3.6 days (p = 0.039). Conclusions: The measurement of patients’ BC can allow for the identification of target patients where PPN has been proven to be an effective tool to improve postoperative outcomes. Full article
(This article belongs to the Special Issue The Role of Perioperative Nutrition Support in Postoperative Recovery)
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Article
Prehabilitation for Bariatric Surgery: A Randomized, Controlled Trial Protocol and Pilot Study
Nutrients 2021, 13(9), 2903; https://doi.org/10.3390/nu13092903 - 24 Aug 2021
Viewed by 775
Abstract
Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and [...] Read more.
Bariatric surgery is the most efficacious treatment for obesity, though it is not free from complications. Preoperative conditioning has proved beneficial in various clinical contexts, but the evidence is scarce on the role of prehabilitation in bariatric surgery. We describe the protocol and pilot study of a randomized (ratio 1:1), parallel, controlled trial assessing the effect of a physical conditioning and respiratory muscle training programme, added to a standard 8-week group intervention based on therapeutical education and cognitive-behavioural therapy, in patients awaiting bariatric surgery. The primary outcome is preoperative weight-loss. Secondary outcomes include associated comorbidity, eating behaviour, physical activity, quality of life, and short-term postoperative complications. A pilot sample of 15 participants has been randomized to the intervention or control groups and their baseline features and results are described. Only 5 patients completed the group programme and returned for assessment. Measures to improve adherence will be implemented and once the COVID-19 pandemic allows, the clinical trial will start. This is the first randomized, clinical trial assessing the effect of physical and respiratory prehabilitation, added to standard group education and cognitive-behavioural intervention in obese patients on the waiting list for bariatric surgery. Clinical Trial Registration: NCT0404636. Full article
(This article belongs to the Special Issue The Role of Perioperative Nutrition Support in Postoperative Recovery)
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Article
Impact of Sarcopenia on Acute Kidney Injury after Infrarenal Abdominal Aortic Aneurysm Surgery: A Propensity Matching Analysis
Nutrients 2021, 13(7), 2212; https://doi.org/10.3390/nu13072212 - 27 Jun 2021
Cited by 1 | Viewed by 728
Abstract
Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether [...] Read more.
Background: Sarcopenia contributes to increased morbidity and mortality in patients undergoing surgery for abdominal aortic aneurysms (AAA). However, few reports have demonstrated whether sarcopenia would affect the development of postoperative acute kidney injury (AKI) in these patients. This study aimed to examine whether sarcopenia is associated with AKI and morbidity and mortality after infrarenal AAA operation. Methods: We retrospectively analysed 379 patients who underwent infrarenal AAA surgery. The diagnosis of sarcopenia was performed using the skeletal muscle index, which was calculated from axial computed tomography at the level of L3. The patients were separated into those with sarcopenia (n = 104) and those without sarcopenia (n = 275). We applied multivariable and Cox regression analyses to evaluate the risk factors for AKI and overall mortality. A propensity score matching (PSM) evaluation was done to assess the postoperative results. Results: The incidence of AKI was greater in sarcopenia than non-sarcopenia group before (34.6% vs. 15.3%; p < 0.001) and after the PSM analysis (34.6% vs. 15.4%; p = 0.002). Multivariable analysis revealed sarcopenia to be associated with AKI before (p = 0.010) and after PSM (p = 0.016). Sarcopenia was also associated with overall mortality before (p = 0.048) and after PSM (p = 0.032). A Kaplan–Meier analysis revealed that overall mortality was elevated patients with sarcopenia before and after PSM than in those without (log-rank test, p < 0.001, p = 0.022). Conclusions: Sarcopenia was associated with increased postoperative AKI incidence and overall mortality among individuals who underwent infrarenal AAA operation. Full article
(This article belongs to the Special Issue The Role of Perioperative Nutrition Support in Postoperative Recovery)
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Article
NutriCatt Protocol Improves Body Composition and Clinical Outcomes in Elderly Patients Undergoing Colorectal Surgery in ERAS Program: A Retrospective Cohort Study
Nutrients 2021, 13(6), 1781; https://doi.org/10.3390/nu13061781 - 23 May 2021
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Abstract
Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center [...] Read more.
Background: A poor body composition, often found in elderly patients, negatively impacts perioperative outcomes. We evaluated the effect of a perioperative nutritional protocol (NutriCatt) on body composition and clinical outcomes in a cohort of elderly patients undergoing colorectal surgery in a high-volume center adopting the ERAS program. Methods: 302 out of 332 elderly (>75 years) patients from 2015 to 2020 were identified. Patients were divided according to their adherence, into “NutriCatt + ERAS” (n = 166) or “standard ERAS” patients (n = 136). Anthropometric and bioelectrical impedance analysis data were evaluated for NutriCatt + ERAS patients. Complications, length of hospital stay (LOS), and other postoperative outcomes were compared between both groups. Results: In NutriCatt + ERAS patients, significant improvements of phase angle (pre-admission vs. admission 4.61 ± 0.79 vs. 4.84 ± 0.85; p = 0.001; pre-admission vs. discharge 4.61 ± 0.79 vs. 5.85 ± 0.73; p = 0.0002) and body cell mass (pre-admission vs. admission 22.4 ± 5.6 vs. 23.2 ± 5.7; p = 0.03; pre-admission vs. discharge 22.4 ± 5.6 vs. 23.1 ± 5.8; p = 0.02) were shown. NutriCatt + ERAS patients reported reduced LOS (p = 0.03) and severe complications (p = 0.03) compared to standard ERAS patients. A regression analysis confirmed the protective effect of the NutriCatt protocol on severe complications (OR 0.10, 95% CI 0.01–0.56; p = 0.009). Conclusions: The NutriCatt protocol improves clinical outcomes in elderly patients and should be recommended in ERAS colorectal surgery. Full article
(This article belongs to the Special Issue The Role of Perioperative Nutrition Support in Postoperative Recovery)
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Review

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Review
Polypharmacy and Malnutrition Management of Elderly Perioperative Patients with Cancer: A Systematic Review
Nutrients 2021, 13(6), 1961; https://doi.org/10.3390/nu13061961 - 07 Jun 2021
Cited by 3 | Viewed by 1678
Abstract
Malnutrition, which commonly occurs in perioperative patients with cancer, leads to decreased muscle mass, hypoalbuminemia, and edema, thereby increasing the patient’s risk of various complications. Thus, the nutritional management of perioperative patients with cancer should be focused on to ensure that surgical treatment [...] Read more.
Malnutrition, which commonly occurs in perioperative patients with cancer, leads to decreased muscle mass, hypoalbuminemia, and edema, thereby increasing the patient’s risk of various complications. Thus, the nutritional management of perioperative patients with cancer should be focused on to ensure that surgical treatment is safe and effective, postoperative complications are prevented, and mortality is reduced. Pathophysiological and drug-induced factors in elderly patients with cancer are associated with the risk of developing malnutrition. Pathophysiological factors include the effects of tumors, cachexia, and anorexia of aging. Metabolic changes, such as inflammation, excess catabolism, and anabolic resistance in patients with tumor-induced cancer alter the body’s ability to use essential nutrients. Drug-induced factors include the side effects of anticancer drugs and polypharmacy. Drug–drug, drug–disease, drug–nutrient, and drug–food interactions can significantly affect the patient’s nutritional status. Furthermore, malnutrition may affect pharmacokinetics and pharmacodynamics, potentiate drug effects, and cause side effects. This review outlines polypharmacy and malnutrition, the impact of malnutrition on drug efficacy, drug–nutrient and drug–food interactions, and intervention effects on polypharmacy or cancer cachexia in elderly perioperative patients with cancer. Full article
(This article belongs to the Special Issue The Role of Perioperative Nutrition Support in Postoperative Recovery)
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Review
The Effect of Perioperative Administration of Probiotics on Colorectal Cancer Surgery Outcomes
Nutrients 2021, 13(5), 1451; https://doi.org/10.3390/nu13051451 - 25 Apr 2021
Cited by 1 | Viewed by 1249
Abstract
The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s [...] Read more.
The perioperative care of colorectal cancer (CRC) patients includes antibiotics. Although antibiotics do provide a certain protection against infections, they do not eliminate them completely, and they do carry risks of microbial resistance and disruption of the microbiome. Probiotics can maintain the microbiome’s balance postoperatively by maintaining intestinal mucosal integrity and reducing bacterial translocation (BT). This review aims to assess the role of probiotics in the perioperative management of CRC patients. The outcomes were categorised into: postoperative infectious and non-infectious complications, BT rate analysis, and intestinal permeability assessment. Fifteen randomised controlled trials (RCTs) were included. There was a trend towards lower rates of postoperative infectious and non-infectious complications with probiotics versus placebo. Probiotics reduced BT, maintained intestinal mucosal permeability, and provided a better balance of beneficial to pathogenic microorganisms. Heterogeneity among RCTs was high. Factors that influence the effect of probiotics include the species used, using a combination vs. single species, the duration of administration, and the location of the bowel resection. Although this review provided evidence for how probiotics possibly operate and reported notable evidence that probiotics can lower rates of infections, heterogeneity was observed. In order to corroborate the findings, future RCTs should keep the aforementioned factors constant. Full article
(This article belongs to the Special Issue The Role of Perioperative Nutrition Support in Postoperative Recovery)
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