Enteral nutrition in surgical patients

Abstract

Purpose: Malnutrition is well-recognized as a potential cause of increased morbidity and mortality in surgical patients; however, enteral and parenteral nutritional support given pre- and postoperatively have been shown to decrease these rates. We conducted a prospective study to assess the short-term efficacy of oral dietary supplementation in malnourished patients undergoing major abdominal surgery.

Methods: Sixty patients undergoing major abdominal surgery were divided according to nutritional risk index into borderline (BM), moderately (MM), and severely (SM) malnourished categories. The patients in each category were randomly divided into a treatment group (TG) and a control group (CG). TG patients were given an oral sip feed containing 500 kcal of energy and 16.66 g of protein in addition to their daily oral intake. The differences in nutritional intake, in terms of energy and protein, and the changes in nutritional status, as assessed by anthropometric, biochemical, and hematological values, complication rates, and duration of stay were compared.

Results: The supplemented feeds were well tolerated and the total caloric and protein intake in the TG was significantly higher than in the CG, at 1798 vs 1182 kcal ( P < 0.01), protein 55.71 vs 39.48 g ( P < 0.01), respectively. Weight loss in the SM patients was significantly less in the TG than in the CG, at 2.15 vs 4.6 kg ( P < 0.001), respectively. Complications developed in 7 of the 30 TG patients and in 10 of the 30 CG patients, with maximum reduction seen in the SM category (7 in the CG vs 4 in the TG).

Conclusions: Patients with severe malnutrition are likely to develop large energy deficits postoperatively, resulting in loss of body mass and a higher incidence of infective complications. Oral nutritional supplements are well tolerated by these patients, and help to improve their energy and routine intake and reduce the risk of complications.