Impact of nutritional status/risk and post-operative nutritional management on clinical outcomes in patients undergoing gastrointestinal surgery: a prospective observational study

Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review

Background

While current wound treatment strategies often focus on antimicrobials and topical agents, the role of nutrition in wound healing and aesthetic outcomes is crucial but frequently overlooked. This review assesses the impact of specific nutrients and preoperative nutritional status on surgical outcomes.

Methods

A comprehensive search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, from the inception of the study to October 2023. The study focused on the influence of macronutrients and micronutrients on aesthetic outcomes, the optimization of preoperative nutritional status, and the association between nutritional status and postoperative complications. Inclusion criteria were English language peer-reviewed articles, systematic reviews, meta-analyses, and clinical trials related to the impact of nutrition on skin wound healing and aesthetic outcomes. Exclusion criteria included non-English publications, non-peer-reviewed articles, opinion pieces, and animal studies.

Results

Omega-3 fatty acids and specific amino acids were linked to enhanced wound-healing and immune function. Vitamins A, B, and C and zinc positively influenced healing stages, while vitamin E showed variable results. Polyphenolic compounds showed anti-inflammatory effects beneficial for recovery. Malnutrition was associated with increased postoperative complications and infections, whereas preoperative nutritional support correlated with reduced hospital stays and complications.

Conclusion

Personalized nutritional plans are essential in surgical care, particularly for enhanced recovery after surgery protocols. Despite the demonstrated benefits of certain nutrients, gaps in research, particularly regarding elements such as iron, necessitate further studies. Nutritional assessments and interventions are vital for optimal preoperative care, underscoring the need for more comprehensive guidelines and research in nutritional management for surgical patients.

Influence of hand dominance, gender, and body mass index on hand grip strength

Background

Hand grip strength (HGS) measurements serve as an objective measure of upper extremity function. Reliable hand strength evaluation is vital for assessing treatment effectiveness.

Objectives

To determine the influence of hand dominance, gender, and body mass index (BMI) on HGS among university students in Ghana.

Method

In our cross-sectional study of 304 participants, height, weight, and BMI were measured using a stadiometer and weighing scale. Hand grip strength was assessed with a dynamometer. We compared HGS in dominant and non-dominant hands for males and females using a paired t-test and analysed the correlation between grip strength and weight, height, and BMI using Pearson's correlation coefficient.

Results

The mean HGS for right-hand dominant (RHD) male participants was 35.62 kg (± 7.36) for the right hand compared with 32.84 kg (± 7.36) for the left hand. For females RHD the mean HGS in the right hand was 24.60 kg (± 6.42) compared to 22.12 kg (± 5.37) in the left hand. The mean weight, height and BMI of participants were 62.86 kg (± 10.30), 1.67 m (± 0.09) and 22.9 kg/m2 (± 4.9), respectively. A significant relationship existed between HGS and height (r = 0.492; p < 0.01) as well as HGS and BMI (r = 0.290; p < 0.01). However, no notable connection was found between HGS and weight (r = 0.001; p = 0.982).

Conclusion

Hand grip strength was significantly stronger in the dominant hand of both males and females.

Clinical implications

Physiotherapists should test HGS objectively and quantitatively for use in disease evaluation, diagnosis, and therapy.

Controlling Nutritional Status (CONUT) score as a prognostic marker for gastrointestinal stromal tumours

BACKGROUND

The Controlling Nutritional Status (CONUT) score, regarded as the effective indicator of patient nutrition, has been demonstrated to be related to prognosis of numerous tumours. Nevertheless, the significance of CONUT for gastrointestinal stromal tumour (GIST) remains unclear. This study intended to clarify the association between CONUT and the prognosis of GISTs.

METHODS

Three hundred and fifty-five patients with GISTs undergoing surgical resection at our center were retrospectively assessed. Receiver operating characteristic curve analysis was used to help determine the cut-off value of CONUT score. Relapse-free survival (RFS) and overall survival (OS) were assessed by Kaplan-Meier curve analysis. Prognostic factors for RFS and OS were examined by Cox proportional hazards models.

RESULTS

A total of 355 patients were enrolled in this study. Areas under the curve (AUC) were 0.638 for CONUT score, and the cut-off value of CONUT was shown to be three. Kaplan-Meier curve analysis showed that high CONUT score was linked to poorer RFS and OS. Univariate and multivariate analyses ultimately revealed that CONUT was a risk factor for RFS and OS, independent of demographics and clinicopathological tumour characteristics.

CONCLUSIONS

CONUT score was an effective and novel predictor for prognosis of GIST patients treated with surgery, indicating its potential as a prognostic marker in the overall management.

Screening for malnutrition in emergency laparotomy patients: a comparison of three tools

INTRODUCTION

Malnourished patients undergoing emergency laparotomy are at risk of significant morbidity. The optimum screening tool to identify such patients in practice and research is yet to be determined. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition in this population.

METHODS

A prospective cohort study (NCT04696367) was conducted across two sites, recruiting patients undergoing National Emergency Laparotomy Audit eligible procedures. Data collected included demographics, diagnosis, procedure and outcomes. Nutrition risk was assessed using three tools: Malnutrition Universal Screening Tool (MUST) score, Nutritional Risk Index (NRI) and Nutritional Risk Score 2002 (NRS-2002). Complications were assessed with the Comprehensive Complication Index. Quality of life was measured at baseline and 5 days postsurgery using EQ-5D-5L.

RESULTS

A total of 59 patients were recruited. Median age was 69 years. Of the 59 participants, 23 were judged high risk using MUST score, 13 using NRS and 8 using NRI. Median time to restart enteral intake was 7 days (interquartile range 7-14). Time without intake was correlated with increasing score using MUST (r=0.463, p<0.001) and NRS-2002 (r=0.296, p=0.03) but not NRI (r=-0.121, p=0.38). High-risk nutritional groups also had increased length of hospital stay, but not complication scores.

CONCLUSIONS

Patients undergoing emergency laparotomy spend a prolonged time without enteral nutrition. Although all nutritional tools demonstrated some propensity to identify patients at higher risk of needing nutritional support, their performance was variable. Nevertheless, some may be useful in future clinical studies.

Factors associated with prolonged postoperative length of hospital stay after laparoscopic colorectal cancer resection: a secondary analysis of a randomized controlled trial

BACKGROUND

The postoperative length of hospital stay (PLOS) is an important indicator of surgical quality. We identified perioperative factors that affect prolonged PLOS (PPLOS) after laparoscopic colorectal cancer resection, which is the preferred surgical approach for colorectal cancer, the third most common cancer.

METHODS

This study was a secondary analysis of a randomized trial (clinicaltrials.gov ID: NCT03160144) that included 280 patients who underwent laparoscopic colorectal cancer resection. The primary outcome was a PPLOS, defined as a PLOS that was longer than the median PLOS. Baseline, anesthetic, surgical, and postoperative management factors were included in the univariate and multivariate analyses to identify factors influencing PPLOS.

RESULTS

The median PLOS was 10 days, and 117 patients had a PPLOS. We identified six influencing factors for PPLOS: preoperative pulse oxygen saturation < 96% (odds ratio [OR], 3.09 [95% confidence interval (CI) 1.38-6.92]; P = 0.006), distant tumor metastasis (OR, 0.34 [95% CI 0.13-0.91]; P = 0.031), the Miles procedure or left hemicolectomy (OR, 4.51 [95% CI 1.67-12.18]; P = 0.003), perioperative surgical events (OR, 2.44 [95% CI 1.25-4.76]; P = 0.009), postoperative albumin infusion (OR, 2.19 [95% CI 1.14-4.19]; P = 0.018), and postoperative early ambulation (OR, 0.35 [95% CI 0.18-0.68]; P = 0.002). Further stratified analysis showed that postoperative albumin infusion might be a risk factor for PPLOS, even in patients with a preoperative albumin level < 40 g/L (OR, 2.29 [95% CI 0.98-5.34]; P = 0.056) or duration of surgery ≥ 3 h (OR, 2.52 [95% CI 1.08-5.87]; P = 0.032).

CONCLUSIONS

A low preoperative pulse oximetry reading, complex surgical procedures, perioperative surgical events, and postoperative albumin infusion may be risk factors for PPLOS after laparoscopic colorectal cancer resection, whereas distant tumor metastasis and postoperative early ambulation might be protective factors. The association between postoperative albumin infusion, a modifiable factor, and PLOS or clinical outcomes warrants further investigation.

Preoperative Nutritional Risk Assessment for Predicting Complications after Radical Cystectomy plus Urinary Diversion for Bladder Cancer

Objective

To investigate the predictive value of preoperative nutritional risk assessment on the occurrence of complications after radical cystectomy plus urinary diversion for bladder cancer.

Methods

Retrospective analysis of 178 patients with bladder cancer between July 2010 and March 2022 who underwent elective radical cystectomy plus urinary diversion was conducted. The occurrence of complications within 90 days after surgery was counted for all patients, and the postoperative complication rates of patients with and without nutritional risk were compared and analyzed. Also, logistic regression analysis was used to assess the relative risk coefficients of NRS-2002 and the occurrence of postoperative complications.

Results

Comparison of clinicopathological characteristics and surgical conditions between the two groups showed that the proportion of combined diabetes mellitus, operative time, and postoperative hospital stay were higher in the nutritional risk group (NRS ≥3 score) than in the no nutritional risk group (NRS <3 score), while the preoperative blood albumin (ALB) level was lower than that in the no nutritional risk group (NRS <3 score). The results of multifactorial risk regression analysis showed that low preoperative ALB level and high NRS score were independent risk factors for postoperative complications in bladder cancer (P < 0.05).

Conclusion

The NRS-2002 nutritional risk score has good predictive value for the incidence of postoperative complications in patients with bladder cancer and provides a scientific basis for perioperative nutritional support.

Nutritional screening in a cancer prehabilitation programme: A cohort study

BACKGROUND

Cancer patients are often malnourished pre-operatively. Study aims were to establish if current screening was appropriate for use in prehabilitation and investigate any association between nutritional risk, functionality and quality of life (QoL).

METHODS

This cohort study used routinely collected data from September 2020 to August 2021 from patients in a Prehab4cancer programme. Included patients were aged >18 years, had colorectal, lung or oesophago-gastric cancer and were scheduled for surgery. Nutritional assessment included patient generated subjective global assessment (PG-SGA) short-form and QoL with a sit-to-stand test. Association between nutritional risk and outcomes were analysed using adjusted logistic regression.

RESULTS

From 928 patients referred to Prehab4Cancer service over 12-months, data on nutritional risk were collected from 526 patients. Pre-operatively, 233 out of 526 (44%) patients were at nutritional risk (score ≥2). During prehabilitation, 31% of patients improved their PG-SGA and 74% of patients maintained or improved their weight. Odds ratios (OR) with confidence intervals (CI) showed that patients with better QoL using EuroQol-5 Dimensions (OR 0.05, 95% CI 0.01, 0.45, P=0.01), EuroQol Visual Analogue Scale (OR 0.96, 95% CI 0.93, 1.00, p=0.04) or sit-to-stand (OR 0.96, 95% 0.93, 1.00, p=0.04) were less likely to be nutritional at risk.

CONCLUSION

Nearly half of patients in Prehab4Cancer programme assessed using PG-SGA were at risk of malnutrition. However, almost half of the sample did not have their risk assessed. Patients at risk of malnutrition were more likely to have a poorer QoL and sit-to-stand test than those who were not at risk. This article is protected by copyright. All rights reserved.

Relationship Between Nutritional Status and Clinical Outcome in Patients With Gastrointestinal Stromal Tumor After Surgical Resection

Background

Currently, gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors in the gastrointestinal tract, and surgical resection is the main treatment. Malnutrition after gastrointestinal surgery is not uncommon, which may have adverse effects on postoperative recovery and prognosis. However, the nutritional status of GIST patients after surgical resection and its impact on clinical outcomes have received less attention. Therefore, the aim of this study was to dynamically evaluate the nutritional status of GIST patients undergoing surgical resection, and to analyze the correlation between nutritional status and clinical outcomes.

Methods

We retrospectively analyzed the clinical data of GIST patients who underwent surgical resection in the Fourth Hospital of Hebei Medical University from January 2016 to January 2020. Nutritional risk screening 2002 (NRS2002) and Patient-Generated Subjective Global Assessment (PG-SGA) were used to assess the nutritional status of all patients at admission and discharge, and the correlation between nutritional risk and clinical outcomes was analyzed.

Results

A total of 413 GIST patients were included in this study, among which 114 patients had malnutrition risk at admission (NRS2002 score ≥ 3), and 65 patients had malnutrition (PG-SGA score ≥ 4). The malnutrition risk rate (27.60 vs. 46.73%, p &lt; 0.001) and malnutrition incidence (15.73 vs. 37.29%, p &lt; 0.001) at admission were lower than those at discharge. Compared with the laboratory results at admission, the albumin, prealbumin, and total protein of the patients at discharge were significantly lower (all p &lt; 0.05). And there was a negative correlation between PG-SGA and clinical outcome (all p &lt; 0.05).

Conclusion

The nutritional status of GIST patients after surgical resection at discharge was worse than that at admission, and malnutrition is an important risk factor leading to poor clinical outcomes.

Assessment of Nutritional Status and Nutrition Impact Symptoms in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study

BACKGROUND

Identification and treatment of malnutrition are essential in upper gastrointestinal (UGI) cancer. However, there is limited understanding of the nutritional status of UGI cancer patients at the time of curative surgery. This prospective point prevalence study involving 27 Australian tertiary hospitals investigated nutritional status at the time of curative UGI cancer resection, as well as presence of preoperative nutrition impact symptoms, and associations with length of stay (LOS) and surgical complications.

METHODS

Subjective global assessment, hand grip strength (HGS) and weight were performed within 7 days of admission. Data on preoperative weight changes, nutrition impact symptoms, and dietary intake were collected using a purpose-built data collection tool. Surgical LOS and complications were also recorded. Multivariate regression models were developed for nutritional status, unintentional weight loss, LOS and complications.

RESULTS

This study included 200 patients undergoing oesophageal, gastric and pancreatic surgery. Malnutrition prevalence was 42% (95% confidence interval (CI) 35%, 49%), 49% lost ≥5% weight in 6 months, and 47% of those who completed HGS assessment had low muscle strength with no differences between surgical procedures (p = 0.864, p = 0.943, p = 0.075, respectively). The overall prevalence of reporting at least one preoperative nutrition impact symptom was 55%, with poor appetite (37%) and early satiety (23%) the most frequently reported. Age (odds ratio (OR) 4.1, 95% CI 1.5, 11.5, p = 0.008), unintentional weight loss of ≥5% in 6 months (OR 28.7, 95% CI 10.5, 78.6, p < 0.001), vomiting (OR 17.1, 95% CI 1.4, 207.8, 0.025), reduced food intake lasting 2-4 weeks (OR 7.4, 95% CI 1.3, 43.5, p = 0.026) and ≥1 month (OR 7.7, 95% CI 2.7, 22.0, p < 0.001) were independently associated with preoperative malnutrition. Factors independently associated with unintentional weight loss were poor appetite (OR 3.7, 95% CI 1.6, 8.4, p = 0.002) and degree of solid food reduction of <75% (OR 3.3, 95% CI 1.2, 9.2, p = 0.02) and <50% (OR 4.9, 95% CI 1.5, 15.6, p = 0.008) of usual intake. Malnutrition (regression coefficient 3.6, 95% CI 0.1, 7.2, p = 0.048) and unintentional weight loss (regression coefficient 4.1, 95% CI 0.5, 7.6, p = 0.026) were independently associated with LOS, but no associations were found for complications.

CONCLUSIONS

Despite increasing recognition of the importance of preoperative nutritional intervention, a high proportion of patients present with malnutrition or clinically significant weight loss, which are associated with increased LOS. Factors associated with malnutrition and weight loss should be incorporated into routine preoperative screening. Further investigation is required of current practice for dietetics interventions received prior to UGI surgery and if this mitigates the impact on clinical outcomes.