Preoperative nutrition in gastrointestinal surgery

Introduction

I chose the topic pre-operative nutrition care for patients undergoing gastrointestinal surgery. Post-operative complications have been majorly attributed to nutritional depletion. An insufficient nutritional intake heightens the nutritional depletion risk patients who have recently undergone gastrointestinal surgery (Hedman et al., 2014). This is also risked by factors such as metabolic rate subsequent increase and surgical stress.

Ensuring that patients who undergo gastrointestinal surgery have a sufficient nutritional intake is a core focus relating to pre-operative care and various methods have been devised to come up with means of according nutritional support (Zimmermann, et al, 2010). The aim is to minimize significantly the surgical trauma resulting from surgery stress and metabolic rate increase.

The PICOT intervention was, in adult patients, how effective is pre-operative nutrition compared to lack of nutrition after undergoing gastrointestinal surgery in establishing nutritional nourishment after surgery. Though there is insufficient research evidence to support pre-operative nutrition there proof that people that are malnourished experience a more positive surgical outcome if they are fed sufficiently for period of at least 10 days pre-operatively.

The surgical trauma experienced induces sympathetic activity and a rise in the secretion of catecholamine. The patient then experiences a protracted hyperactive metabolic state and an undesirable nitrogen balance follows (El-Badawy, 2014). The metabolic rate increases by around 10%. Adequate nutrition should be provided at this stage to avoid a further increase in the metabolic rate. 

In the immediate post-operative period, intestinal permeability increases to fourfold but returns to normal after a period of five days. An increase in intestinal permeability is associated with nutritional depletion and a villous height decrease.

Beneficial and appropriate nutritional support in patients who are severely depleted improves the clinical outcome and their nutritional status. There is evidence of this improvement in decreased morbidity and a reduced hospital stay. It also reduces hospital costs and morbidity while greatly improving the patient’s life quality. 

Due to concerns of resulting post-operative ileus, bowel resection is followed by conventional treatment and involves starvation with administering intravenous fluids to aid flatus passage because of the basic assumption that if ileus is present, oral feeding may not be advised. Enteral feeding is however tolerated in gastrointestinal surgery patients even if administered within 12 hours of surgery.  

One should consider an appropriate method of delivery, which is determined by the enteral feeding anticipated duration. Enteral feeding show positive feedback such as a much improve response to wound healing and a decrease in the chances of infectious complications after the surgery (Burden, Todd, Hill & Lal, 2010).

Total parental nutrition (TPN) is a consideration for patients who are extremely malnourished with gastrointestinal malignancy (PAWLIK, 2016). When fed pre-operatively for a period of ten days, there is a significant decrease in no-infectious and infectious complications although it has no impact on mortality or morbidity.

If malnourished clients are fed sufficiently pre-operatively for a period of 7-10 days, there are chances of improvement in the surgical outcome. It however results in prolonged stay in the hospital due to delay in surgical operation. Pre-operative nutrition is also important for patients suffering from inflammatory bowel disease and increases life quality if appropriately intervened (da Silveira, de Oliveira Carvalho & Cataneo, 2012).

Conclusion

In conclusion, malnutrition in patients due for surgery is a major setback for successful post-operative outcome. It risks complications to the patient whether infectious or non-infectious. Nutritional Screening pre-operatively is crucial to identify patients who are in need of nutritional support. Immuno-nutrition and oral supplementation is adequate for most patients. The benefits accruing from pre-operative nutritional support are evidence for more clinical efforts that should be affected.

References

Burden, S., Todd, C., Hill, J., & Lal, S. (2010). Preoperative Nutrition in Patients Undergoing Gastrointestinal Surgery. Cochrane Database Of Systematic Reviews.

da Silveira, R., de Oliveira Carvalho, P., & Cataneo, A. (2012). Interventions for reducing diarrhoea in patients receiving chemotherapy for colorectal cancer. Cochrane Database Of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd009615

El-Badawy, H. A. A. E. H. (2014). Anastomotic Leakage after Gastrointestinal Surgery: Risk Factors, Presentation and Outcome \\ The Egyptian Journal of Hospital Medicine .- 2014, Vol. 57, pp. 494-512. Cairo: Pan Arab League of Continuous Medical Education.

Hedman, S. A., Fuzy, J. L., & Rymer, S. A. (2014). Hartman’s nursing assistant care: Long-term care. Albuquerque, N.M: Hartman Pub.

PAWLIK, T. I. M. O. T. H. Y. M. (2016). GASTROINTESTINAL SURGERY. Place of publication not identified: SPRINGER-VERLAG NEW YORK.Zimmermann, J., Turzo, M., Roggenbach, J., Jensen, K., Diener, M., & Seiler, C. et al. (2010). Perioperative corticosteroids for patients undergoing elective major abdominal surgery (CORPUS). Cochrane Database Of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd008899