New study pushes for optimizing nutrition post-surgery

More than 48 million people in the U.S. undergo surgery each year, and for decades the focus has been on making sure patients do not consume any food or drinks in the hours leading up to the surgery. Yet, 1 in 3 patients are malnourished or at risk of malnutrition when they're admitted to the hospital, and many are unaware of it. New research from Advocate Health Care shows that this lack of nutrition could have major health implications on patients' surgical outcomes.

As part of a real-world evidence study, Advocate Health Care implemented a nutrition care program at four of its Chicago area hospitals to help ensure their patients are nourished during their hospital stay and post-discharge. The latest data, published in The Journal of Parenteral and Enteral Nutrition, looked at the role of nutrition care for at risk or malnourished medical and surgical patients. Researchers found that the more than 300 malnourished surgical patients who received nutrition care, had reduced hospital readmission rates by nearly 50 percent after 30 days of being discharged and the average length of stay by 2.7 days, according to the study, which was funded by Abbott Laboratories, a healthcare company headquartered in Lake Bluff, Illinois.

Malnutrition occurs when the body doesn't get the nutrients it needs, but often goes undiagnosed because it can be invisible to the eye in both underweight and overweight individuals. Because surgeries take a large toll on a patient's body, addressing malnutrition can help set patients up for a more successful recovery. Previous research has found that malnourished patients undergoing surgery could experience delayed wound healing, surgical site infections, a longer length of stay, and higher rates of hospital readmission.

''Surgeries can be complex, but when it comes to addressing nutrition for patients, it's quite simple,'' said Suela Sulo, PhD, a researcher at Abbott and one of the study authors. ''The research shows when we screen, feed, and follow patients' nutritional status in the hospital and after they are discharged, we are helping them have the best chances of a successful recovery.''

As more hospitals reevaluate their surgical protocols, medical guidelines are catching up. At the ASPEN 2018 Nutrition Science and Practice Conference earlier this year, a group of international experts from the American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative developed new guidelines for surgery-related nutrition. These guidelines call for routine pre-surgery nutrition screening to identify patients in need of nutrition optimization, and to restart nutrition supplementation immediately after surgery. As the lead author of the guidelines, Paul Wischmeyer, MD, an anesthesiologist and critical care specialist at Duke University Hospital, is pioneering how we address surgical malnutrition today.⁸

''Malnutrition is a silent epidemic in our healthcare system," said Wischmeyer. ''As an anesthesiologist, I have seen first-hand the impact addressing malnutrition can have on patients and their recovery. Something that may take five minutes for us as doctors to do can have a long-lasting impact on patients—keeping them out of the hospital and making a big difference in their quality of life at the end of the day.''

References:

1. NCHS, National Hospital Ambulatory Medical Care Survey, 2010. https://www.cdc.gov/nchs/data/nhsr/nhsr102.pdf 
2. Coats KG et al. J Am Diet Assoc. 1993; 93:27-33. 
3. Thomas DR et al. Am J Clin Nutr. 2002; 75: 308-313. 
4. Sriram, Krishnan, et al. JPEN. 2018; https://doi.org/10.1002/jpen.1040 
5. Kruizenga H et al. Am J Clin Nutr. 2016;103(4):1026-1032. 
6. Allard JP et al. Clin Nutr. 2016;35(1):144-152. 
7. Thomas MN et al. Nutrition. 2016;32(2):249-254. 
8. Dr. Wischmeyer is a health adviser to Abbott