Is perioperative fasting associated with complications, length of hospital stay and mortality among gastric and colorectal cancer patients? A cohort study

Taste preference of patients shortly after surgery in the Post Anaesthesia Care Unit (PACU)

BACKGROUND & AIMS

Early postoperative oral feeding is safe and enhances recovery after surgery. To facilitate oral intake directly after surgery in the Post Anaesthesia Care Unit (PACU) and to enhance its associated benefits, knowledge on what patients would like to eat and/or drink is essential. Data on taste preferences in the immediate postoperative period is scarce, therefore this study investigated the taste preference of patients directly after surgery in the PACU.

METHODS

A prospective observational study in adult patients scheduled for elective surgery under general anaesthesia. Taste preference was our primary outcome, for which we used the Macronutrient and Taste Preference Ranking Task (MTPRT) questionnaire. As secondary outcomes we asked additional questions to evaluate specific food characteristics separately, including consistency, texture, and temperature of food/drinks. Finally, we evaluated the appetite of our patients, using descriptive statistics, and analysing differences in the MTPRT liking scores.

RESULTS

We included 57 surgical patients. The MTPRT liking data showed that our patients liked low-energy products with a sweet taste the most. The MTPRT ranking data showed a dislike for high-protein products. Data from the additional questionnaire revealed that our patients seemed to like food products with soft, juicy, crispy, hot and cold characteristics. The majority of patients (n = 44, 79 %) did have an appetite for food directly after surgery during their PACU admission.

CONCLUSION

This study showed that postoperative patients in the PACU tended to like low-energy food products with a sweet taste the most. In addition, this study showed that patients seemed to favour a broad variety of food products directly after surgery. Due to our small sample size the results should be interpreted with caution, but they do provide initial insights to help improve PACU food services, and thereby can contribute to enhance early postoperative oral intake. Registered at NTR (trialregister.nl) with study ID Trial NL9048.

Association between preoperative fasting time and clinical outcomes in surgical patients in a private general hospital

PURPOSE

Surgical patients are routinely subjected to long periods of fasting, a practice that can exacerbate the metabolic response to trauma and impair postoperative recovery. The aim of this study was to evaluate the association between preoperative fasting time and clinical outcomes in surgical patients.

METHODS

An observational, prospective study with a non-probabilistic sample that included patients of both sexes, aged over 18, undergoing elective surgeries. Data were extracted from electronic medical records, and a questionnaire was applied in 48 hours after surgery. Variables related to postoperative discomfort were assessed using an 11-point numeric rating scale.

RESULTS

The sample consisted of 372 patients, and the duration of the surgical event ranged from 30-680 minutes. The incidence of nausea (26.34%) was twice that of vomiting (13.17%) and showed an association with the surgical procedure's size (p = 0.018). A statistically significant difference was observed only between pain intensity and preoperative fasting times for liquids (p = 0.007) and postoperative fasting time (p = 0.08). The occurrence of postoperative complications showed no association with preoperative fasting time (p = 0.850).

CONCLUSIONS

Although no association was observed between preoperative fasting time and surgical complications, it is noteworthy that both recommended and actual fasting time exceeded the proposed on clinical guidelines.

Perioperative Nutritional Management in Enhanced Recovery after Bariatric Surgery

Obesity is a crucial health problem because it leads to several chronic diseases with an increased risk of mortality and it is very hard to reverse with conventional treatment including changes in lifestyle and pharmacotherapy. Bariatric surgery (BS), comprising a range of various surgical procedures that modify the digestive tract favouring weight loss, is considered the most effective medical intervention to counteract severe obesity, especially in the presence of metabolic comorbidities. The Enhanced Recovery After Bariatric Surgery (ERABS) protocols include a set of recommendations that can be applied before and after BS. The primary aim of ERABS protocols is to facilitate and expedite the recovery process while enhancing the overall effectiveness of bariatric procedures. ERABS protocols include indications about preoperative fasting as well as on how to feed the patient on the day of the intervention, and how to nourish and hydrate in the days after BS. This narrative review examines the application, the feasibility and the efficacy of ERABS protocols applied to the field of nutrition. We found that ERABS protocols, in particular not fasting the patient before the surgery, are often not correctly applied for reasons that are not evidence-based. Furthermore, we identified some gaps in the research about some practises that could be implemented in the presence of additional evidence.

Body mass index-based predictions and personalized clinical strategies for colorectal cancer in the context of PPPM

Currently colorectal cancer (CRC) is the third most prevalent cancer worldwide. Body mass index (BMI) is frequently used in CRC screening and risk assessment to quantitatively evaluate weight. However, the impact of BMI on clinical strategies for CRC has received little attention. Within the framework of the predictive, preventive, and personalized medicine (3PM/PPPM), we hypothesized that BMI stratification would affect the primary, secondary, and tertiary care options for CRC and we conducted a critical evidence-based review. BMI dynamically influences CRC outcomes, which helps avoiding adverse treatment effects. The outcome of surgical and radiation treatment is adversely affected by overweight (BMI ≥ 30) or underweight (BMI < 20). A number of interventions, such as enhanced recovery after surgery and robotic surgery, can be applied to CRC at all levels of BMI. BMI-controlling modalities such as exercise, diet control, nutritional therapy, and medications may be potentially beneficial for patients with CRC. Patients with overweight are advised to lose weight through diet, medication, and physical activity while patients suffering of underweight require more focus on nutrition. BMI assists patients with CRC in better managing their weight, which decreases the incidence of adverse prognostic events during treatment. BMI is accessible, noninvasive, and highly predictive of clinical outcomes in CRC. The cost-benefit of the PPPM paradigm in developing countries can be advanced, and the clinical benefit for patients can be improved with the promotion of BMI-based clinical strategy models for CRC.