For Publishers
DiscoveryMetadataPeer reviewHostingPublishing
For Researchers
JoinPublishReviewCollect
Register
Blog
About
Search
Advanced search
My ScienceOpen
Search
For Publishers
For Researchers
Blog
About
42
views
10
references
 Top references
cited by
1
    
0 reviews
 Review
0
comments
 Comment
0
recommends
+1 Recommend
0 collections
    0
    shares
      163
      similar
       All similar
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Impact of nutritional support that does and does not meet guideline standards on clinical outcome in surgical patients at nutritional risk: a prospective cohort study

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Objective

          To investigate the impact of nutritional support on clinical outcomes in patients at nutritional risk who receive nutritional support that meets guideline standards and those who do not.

          Methods

          This prospective cohort study enrolled hospitalized patients from the Second Affiliated Hospital of Kunming Medical University from February 2010 to June 2012. The research protocols were approved by the university’s ethics committee, and the patients signed informed consent forms. The clinical data were collected based on nutritional risk screening, administration of enteral and parenteral nutrition, surgical information, complications, and length of hospital stay.

          Results

          During the study period, 525 patients at nutritional risk were enrolled in the cohorts. Among patients who received nutritional support that met the guideline standards (Cohort 1), the incidence of infectious complications was lower than that in patients who did not meet guideline standards (Cohort 2) (17.1 % vs. 26.9 %, P = 0.01). Subgroup analysis showed that individuals who received a combination of parenteral nutrition (PN) and enteral nutrition (EN) for 7 or more days had a significantly lower incidence of infectious complications ( P = 0.001) than those who received only PN for 7 or more days or those who received nutritional support for less than 7 days or at less than 10 kcal/kg/d. Binary logistic regression analysis showed that, after adjusting for confounding factors, nutritional support that met guideline standards for patients with nutritional risk was a protective factor for complications (OR: 0.870, P < 0.002).

          Conclusions

          In patients at nutritional risk after abdominal surgery, nutritional support that meets recommended nutrient guidelines (especially regimens involving PN + EN ≥ 7 days) might decrease the incidence of infectious complications and is worth recommending; however, well-designed trials are needed to confirm our findings. Nutritional support that does not meet the guideline standards is considered clinically undesirable.

          Related collections

          Most cited references10

          • Record: found
          • Abstract: found
          • Article: not found

          American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis.

          (1992)
          To define the terms "sepsis" and "organ failure" in a precise manner. Review of the medical literature and the use of expert testimony at a consensus conference. American College of Chest Physicians (ACCP) headquarters in Northbrook, IL. Leadership members of ACCP/Society of Critical Care Medicine (SCCM). An ACCP/SCCM Consensus Conference was held in August of 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic variables by which a patient could be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods were recommended when dealing with septic patients as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae.
          Article 0 comments Cited 597 times – based on 0 reviews     Review now
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Perioperative total parenteral nutrition in surgical patients. The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group.

            G. Buzby (1991)
            We undertook this study to test the hypothesis that perioperative total parenteral nutrition (TPN) decreases the incidence of serious complications after major abdominal or thoracic surgical procedures in malnourished patients. We studied 395 malnourished patients (99 percent of them male) who required laparotomy or noncardiac thoracotomy. They were randomly assigned to receive either TPN for 7 to 15 days before surgery and 3 days afterward (the TPN group) or no perioperative TPN (the control group). The patients were monitored for complications for 90 days after surgery. The rates of major complications during the first 30 days after surgery in the two groups were similar (TPN group, 25.5 percent; control group, 24.6 percent), as were the overall 90-day mortality rates (13.4 percent and 10.5 percent, respectively). There were more infectious complications in the TPN group than in the controls (14.1 vs. 6.4 percent; P = 0.01; relative risk, 2.20; 95 percent confidence interval, 1.19 to 4.05), but slightly more noninfectious complications in the control group (16.7 vs. 22.2 percent; P = 0.20; relative risk, 0.75; 95 percent confidence interval, 0.50 to 1.13). The increased rate of infections was confined to patients categorized as either borderline or mildly malnourished, according to Subjective Global Assessment or an objective nutritional assessment, and these patients had no demonstrable benefit from TPN. In contrast, severely malnourished patients who received TPN had fewer noninfectious complications than controls (5 vs. 43 percent; P = 0.03; relative risk, 0.12; 95 percent confidence interval, 0.02 to 0.91), with no concomitant increase in infectious complications. The use of preoperative TPN should be limited to patients who are severely malnourished unless there are other specific indications.
            Article 0 comments Cited 158 times – based on 0 reviews     Review now
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              ESPEN Guidelines on Parenteral Nutrition: surgery.

              M. Braga, O Ljungqvist, P Soeters … (2009)
              In modern surgical practice it is advisable to manage patients within an enhanced recovery protocol and thereby have them eating normal food within 1-3 days. Consequently, there is little room for routine perioperative artificial nutrition. Only a minority of patients may benefit from such therapy. These are predominantly patients who are at risk of developing complications after surgery. The main goals of perioperative nutritional support are to minimize negative protein balance by avoiding starvation, with the purpose of maintaining muscle, immune, and cognitive function and to enhance postoperative recovery. Several studies have demonstrated that 7-10 days of preoperative parenteral nutrition improves postoperative outcome in patients with severe undernutrition who cannot be adequately orally or enterally fed. Conversely, its use in well-nourished or mildly undernourished patients is associated with either no benefit or with increased morbidity. Postoperative parenteral nutrition is recommended in patients who cannot meet their caloric requirements within 7-10 days orally or enterally. In patients who require postoperative artificial nutrition, enteral feeding or a combination of enteral and supplementary parenteral feeding is the first choice. The main consideration when administering fat and carbohydrates in parenteral nutrition is not to overfeed the patient. The commonly used formula of 25 kcal/kg ideal body weight furnishes an approximate estimate of daily energy expenditure and requirements. Under conditions of severe stress requirements may approach 30 kcal/kg ideal body weights. In those patients who are unable to be fed via the enteral route after surgery, and in whom total or near total parenteral nutrition is required, a full range of vitamins and trace elements should be supplemented on a daily basis.
              Article 0 comments Cited 135 times – based on 0 reviews     Review now
                Bookmark
                All references

                Author and article information

                Contributors
                Da-Li Sun: destinyky@163.com
                Wei-Ming Li: liweiming@163.com
                Shu-Min Li: lishuming2006310@163.com
                Yun-Yun Cen: destinyky@sina.com
                Yue-ying Lin: destiny1978@sohu.com
                Qing-Wen Xu: xuqingwen1220@qq.com
                Yi-Jun Li: ainiyiwannian20@sina.com.cn
                Yan-Bo Sun: syb0311@163.com
                Yu-xing Qi: 1154180827@qq.com
                Ting Yang: yangting1110@yahoo.com
                Qi-Ping Lu: +86 1387 116 0000 , ptwklqp111@163.com
                Peng-Yuan Xu: +86 1301 333 1809 , destiny1978@163.com , pyxu778@sina.com
                Journal
                Journal ID (nlm-ta): Nutr J
                Journal ID (iso-abbrev): Nutr J
                Title: Nutrition Journal
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1475-2891
                Publication date (Electronic): 19 August 2016
                Publication date PMC-release: 19 August 2016
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 78
                Affiliations
                [1 ]Department of General Surgery, Wuhan Clinical School of Southern Medical University/Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430070 China
                [2 ]Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, 650101 China
                [3 ]Research Center for Surgical Clinical Nutrition in Yun-Nan Province, Kunming, 650101 China
                Article
                Publisher ID: 193
                DOI: 10.1186/s12937-016-0193-6
                PMC ID: 4991079
                PubMed ID: 27543156
                SO-VID: bf5e8475-33af-4c37-bac6-6e8f090799c2
                Copyright © © The Author(s). 2016
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 8 June 2016
                Date accepted : 1 August 2016
                Funding
                Funded by: Foundation of Research Center for Surgical Clinical Nutrition in Yun-Nan Province
                Award ID: 2014NS089
                Funded by: the Professor Yang Hua Research Station in Yun-Nan Province
                Funded by: The National Natural Science Fund
                Award ID: 81160114
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2016

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: nutritional risk,outcome,guidelines,abdominal surgery patients,logistic regression analysis
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: nutritional risk, outcome, guidelines, abdominal surgery patients, logistic regression analysis

                Comments

                Comment on this article

                scite_

                Similar content163

                See all similar

                Cited by1

                See all cited by

                Most referenced authors224

                See all reference authors