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. 2017 Jun;213(6):1010-1018.
doi: 10.1016/j.amjsurg.2016.10.008. Epub 2016 Nov 17.

Assessment of perioperative nutrition practices and attitudes-A national survey of colorectal and GI surgical oncology programs

J D Williams  1 , Paul E Wischmeyer  2
Affiliations

Assessment of perioperative nutrition practices and attitudes-A national survey of colorectal and GI surgical oncology programs

J D Williams et al. Am J Surg. 2017 Jun.

Abstract

Background: Implementation of evidence-based peri-operative nutrition in the U.S. is poorly described and hypothesized to be suboptimal. This study broadly describes practices and attitudes regarding nutrition screening/intervention in U.S. gastrointestinal and oncologic surgeons.

Methods: Nationwide nutritional practice survey of GI/Oncologic surgical faculty.

Results: Program response rates were 57% and 81% for colorectal and oncology fellowships, respectively. Only 38% had formal nutritional screening processes in place. Average estimated percent of patients malnourished, receiving nutritional screening, and receiving nutritional supplementation preoperatively were 28%, 43%, and 21%, respectively. University-affiliation (p = 0.0371) and a formal screening process (p = 0.0312) predicted higher preoperative nutritional screening rates. Controversy existed regarding routine use of perioperative immunonutrition, but strong consensus emerged that lack of awareness regarding positive data for immunonutrition impedes usage.

Conclusion: U.S. surgeons recognize importance of perioperative nutritional screening and benefits of basic nutrition therapy. However, limited formal nutrition screening programs currently exist indicating a significant need for implementation of nutrition screening and basic nutrition intervention. Further work on education, implementation and identifying clinical research needs for immunonutrition interventions is also vitally needed.

Summary: This study broadly describes nutritional practices and attitudes of gastrointestinal and oncologic surgeons across the U.S. Surgeons recognize both the importance of proper perioperative surgical nutritional support and the potential value to their practice in terms of outcomes, but this study confirms poor implementation of evidence-based nutrition practices in GI and oncologic surgery programs. This study describes a significant opportunity to capitalize on current favorable surgeon beliefs (and positive published data) regarding the benefit of perioperative nutrition to improve surgical nutrition practice and patient outcomes in the U.S.

Keywords: Colorectal surgery; Gastrointestinal surgery; Immunonutrition; Malnutrition; Nutrition screening; Nutrition support; Oncologic surgery; Perioperative; Quality improvement; Surgical outcomes.

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Figures

Figure 1.
Figure 1.. Who is Responsible for Nutritional Screening
Responsible parties for nutritional screening in clinical practice, represented by the frequency of each party as chosen by survey respondents.
Figure 2.
Figure 2.. When Nutritional Screening and Supplementation is Conducted
Venn diagrams showing the timing of both nutritional screening and nutritional supplementation (categorized as pre-operatively only, post-operatively only, pre- and postoperatively, or not performed).
Figure 3.
Figure 3.. How Nutritional Screening is Performed
Methods employed during nutritional screening in clinical practice, represented by the frequency of each method as chosen by survey respondents (categorized as biometric measurements, scoring tools, lab values, clinical parameters, and subjective measurements).
Figure 4.
Figure 4.. Assessment of Barriers and Evidence in Nutritional Practice
Selected assessment and barriers to optimal nutritional practice, represented by the percent of respondents who agree or disagree with each barrier or evidence statement.
Figure 5.
Figure 5.. Framework for Improving Surgical Nutrition Support
A proposed framework to improve nutritional practice that includes key shareholders and highlights actionable activities.
See this image and copyright information in PMC

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