Preoperative Nutrition-Enhanced Recovery After Surgery Protocol for Thoracic Neoplasms
Robinson LA, Tanvetyanon T, Grubbs D, Robinson NA, Pierce CM et al.
J Thorac Cardiovasc Surg 2021;162(3):710-720.
Objective:
To evaluate outcomes associated with a preoperative nutrition program used for a two-year period vs. previous standard of care.
Methods:
Retrospective review of patients receiving curative surgery from the same surgeon for thoracic cancers (largely lung). A normally nourished study group (n=229) that was surgeon educated on a preoperative nutritional-enhanced recovery after surgery (N-ERAS) protocol was compared with a normally nourished historical control (n=233) receiving only standard preoperative nutrition. The N-ERAS presurgical protocol included an oral immunonutrition (IM) drink containing L-arginine, n-3 fatty acids and nucleotides (IMPACT Advanced Recovery®) taken for 5 days, daily multispecies probiotics and 1-2 doses of a carbohydrate-loading drink. IM supplementation continued during hospitalization.
Results:
- Favorable reductions associated with use of the N-ERAS Protocol:
- Patient compliance to N-ERAS approached 100% and patients expressed feeling empowered to participate in their care.
- Given the reduction in hospital costs (mean $2198 per patient), the hospital projected a savings of $503,342 over two years.
- Multivariable analysis found use of N-ERAS independently predicted the absence of complications (odds ratio [OR], 0.46; 95% CI, 0.26-0.79; p = 0.005).
- Propensity score matching produced 169 well balanced pairs confirming N-ERAS was associated with an absence of complications (p = 0.003), a mean reduction in hospital stay of 0.5 days (p = 0.001), and a reduction in hospitals costs by a mean $2252 (p < 0.001).
Conclusions:
• The N-ERAS protocol is patient compliant and when added to fast-track thoracic cancer surgery resulted in accelerated recovery. Consideration of use is appropriate to general thoracic surgeons using any technical approach
Please use the link to access the article: Preoperative nutrition-enhanced recovery after surgery protocol for thoracic neoplasms - PubMed (nih.gov)
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