Early Nutrition Impact on Post Abdominal Surgery Outcome

Impact of Early Enteral & Parenteral Nutrition on Post-operative Outcome After Abdominal Surgery

Introduction: Nutritional support is a vital therapy of most surgical patients. Early initiation via the enteral route has a significant effect on postoperative recovery. The prognostic role of CRP and albumin can be explained by their abilities to reflect inflammation in the acute phase in critical settings and assess the nutritional status of critically ill patients, respectively. This indicates the prognostic value of the CRP/ALB ratio in postoperative patients admitted to the ICU.

Aim of work: Determine the effect of early enteral & parenteral nutrition on ICU outcome & nutritional status in postoperative abdominal surgical patients and investigate the effect of enteral & parenteral nutrition on CRP/albumin ratio as an inflammatory marker & its correlation with SOFA score.

Methods: A prospective cohort non randomized study included 80 postoperative abdominal surgical patients at Critical Care Department, Cairo University over one year duration. Forty patients (50%) received enteral nutrition 6 hours after surgical procedures and 40 patients (50%) received parenteral nutrition 6 hours after surgical procedures. Nutritional status and inflammatory markers were screened. All patients were followed up during the ICU stay & up to 3 months. SOFA scoring was done every 48 hours.

Study Overview

• Status: Completed
• Conditions: Postoperative Nutrition
• Intervention / Treatment: Dietary supplement: postoperative nutrition

• Study Type: Observational
• Enrollment (Actual): 80

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 80 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study included patients with age more than 18 years underwent major abdominal surgeries.

Pre-operative nutrition screening was done using Nutritional risk screening (NRS 2000).

Patients were divided into two groups: Group A: 40 patients (50%) received enteral nutrition 6 hours after surgical procedure & Group B: 40 patients (50%) received parenteral nutrition 6 hours after surgical procedure according to the surgeons preference.

Enteral feeding in group (A) was started 6 hours postoperatively via ryle tube or feeding jejunostomy including proteins (1.5 gm/kg/day) with a caloric value (4.1 kcal/gm), fat (caloric value = 9 kcal/gm) & carbohydrates.

Parenteral feeding in group (B) was started 6 hours postoperatively using SmofKabiven Peripheral [FRESENIUS KABI] : 1200 ml , 38 gm amino acids, 34 gm lipids, 85 gm glucose, osmolarity 850 mosmol/L with total energy approximately 800Kcal.

Description

Inclusion Criteria:

• postoperative abdominal surgical patients at Critical Care Department, Cairo University over one year duration.
• age between 18-80 years

Exclusion Criteria:

• renal failure
• liver failure
• extensive burns
• hemodynamic instability.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Enteral Nutrition	Dietary supplement: postoperative nutrition; Forty patients (50%) received enteral nutrition 6 hours after surgical procedures and 40 patients (50%) received parenteral nutrition 6 hours after surgical procedures.
Parenteral nutrition	Dietary supplement: postoperative nutrition; Forty patients (50%) received enteral nutrition 6 hours after surgical procedures and 40 patients (50%) received parenteral nutrition 6 hours after surgical procedures.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gastro-intestinal tolerance: vomitting or diarrhea	number of participants who develop nausea, vomitting or diarrhea	7 days
Refeeding syndrome; hypokalemia and hypophosphatemia	number of participants who develop hypokalemia and hypophosphatemia	7 days
length of ICU stay	measurement of days of ICU stay	7 days
duration of mechanical ventilation.	measurement of days of mechanical ventilation	7 days

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
3 months survival after discharge .	measurement of the rate of survival within 3 months between participants	90 days
re-admission within 30 days	measurement of the rate of hospital re-admission within 30 days between participants	30 days

Collaborators and Investigators

• Sponsor: Cairo University

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2017
• Primary Completion (ACTUAL): June 1, 2018
• Study Completion (ACTUAL): January 1, 2019

Study Registration Dates

• First Submitted: September 20, 2020
• First Submitted That Met QC Criteria: September 23, 2020
• First Posted (ACTUAL): September 28, 2020

Study Record Updates

• Last Update Posted (ACTUAL): September 30, 2020
• Last Update Submitted That Met QC Criteria: September 28, 2020
• Last Verified: September 1, 2020

More Information

Terms related to this study

• Other Study ID Numbers: MS-311-2016

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No