Postoperative fasting is associated with longer ICU stay in oncologic patients undergoing elective surgery

Caroline Fachini, Claudio Z Alan, Luciana V Viana, Caroline Fachini, Claudio Z Alan, Luciana V Viana

Abstract

Background: Cancer patients present nutritional and complications risks during the postoperative period. Fasting contributes to surgical catabolic damage. This study evaluates the consequence of fasting time on the surgical outcomes of cancer patients undergoing elective surgeries.

Methods: Prospective cohort, evaluating two categories of patients according to postoperative fasting: less than or greater than 24 h.

Outcomes: Hospitalization time, 28-day mortality, ICU stay and infection rates.

Discussion: We included 109 patients (57% men, 60 ± 15 years, BMI: 26 ± 5 kg/m2, SAPS3 43 ± 12), hepatectomy was the most frequent surgery (13.8%), and colon and rectum were the most common neoplasia (18.3%). The ICU stay was longer in postoperative fasting > 24 h (5.5 [4-8.25] vs. 3 [2-5] days, p < 0.001). Fasting > 24 h persisted as a risk factor for longer length of stay (LOS) in the ICU after adjustments. There were no differences in the mortality analysis within 28 days and total hospitalization time between groups. A tendency to experience more infections was observed in patients who fasted > 24 h (34.8% vs. 16.3%, p = 0.057). Onset of diet after the first 24 h postoperatively was a risk factor for longer ICU stay in cancer patients who underwent major surgeries.

Keywords: Fasting; Length of stay; Surgical oncology.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Flowchart of patients included in the study

References

    1. Arends J, Baracos V, Bertz H, Bozzetti F, Calder PC, Deutz NEP, et al. ESPEN expert group recommendations for action against cancer-related malnutrition. Clin Nutr. 2017;36(5):1187–1196. doi: 10.1016/j.clnu.2017.06.017.
    1. Assis MC, Silveira CR, Beghetto MG, Mello E. Is duration of postoperative fasting associated with infection and prolonged length of stay in surgical patients? Nutr Hosp. 2014;30(4):919–926.
    1. Assis MCS, Silveira CRM, Beghetto MG, Mello ED. ¿Duracion del ayuno postoperatorio se asocia con la infeccion y la estancia prolongada en pacientes quirurgicos? Nutr Hosp. 2014;30(4):919–926.
    1. Baker JP, Detsky AS, Wesson DE, et al. Nutritional assessment: a comparison of clinical judgment and objective measurements. N Engl J Med. 1982;306(16):969–972. doi: 10.1056/NEJM198204223061606.
    1. Berger MM, Chiolero RL. Enteral nutrition and cardiovascular failure: from myths to clinical practice. J Parenter Enteral Nutr. 2009;33(6):702–709. doi: 10.1177/0148607109341769.
    1. Berger MM, Pichard C, Fontaine E. Optimal energy delivery and measured energy expenditure – impact of length of stay. Crit Care. 2017;21:39. doi: 10.1186/s13054-017-1612-6.
    1. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–1251. doi: 10.1016/0895-4356(94)90129-5.
    1. Charoenkwan K, Matovinovic E. Early versus delayed oral fluids and food for reducing complications after major abdominal gynaecologic surgery. Cochrane Database Syst Rev. 2014;2014:12.
    1. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235–239. doi: 10.1016/S0261-5614(02)00215-7.
    1. Dag A, Colak T, Turkmenoglu O, Gundogdu R, Aydin S. A randomized controlled trial evaluating early versus traditional oral feeding after colorectal surgery. Clinics (Sao Paulo). 2011;66(12):2001–2005. doi: 10.1590/S1807-59322011001200001.
    1. De-Aguilar-Nascimento JE, Salomão AB, Waitzberg DL, Dock-Nascimento DB, Correa MITD, Campos ACL, et al. Diretriz ACERTO de intervenções nutricionais no perioperatório em cirurgia geral eletiva. Rev Col Bras Cir. 2017;44(6):633–648. doi: 10.1590/0100-69912017006003.
    1. Dickerson SC. Perioperative guidelines in anesthesia. Otolaryngol Clin North Am. 2019;52(6):981–993. doi: 10.1016/j.otc.2019.08.001.
    1. Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically Ill patients. N Engl J Med. 2009;360(13):1283–1297. doi: 10.1056/NEJMoa0810625.
    1. Finlayson EVA, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery a national study. Arch Surg. 2003;138(7):721–5. doi: 10.1001/archsurg.138.7.721.
    1. Gershengorn HB, Garland A, Gong MN. Patterns of daily costs differ for medical and surgical intensive care unit patients. Ann Am Thorac Soc. 2015;12(12):1831–1836. doi: 10.1513/AnnalsATS.201506-366BC.
    1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in Hospital Mortality Associated with Inpatient Surgery. N. Engl. J. Med. 2009;361(14):1368–1375. doi: 10.1056/NEJMsa0903048.
    1. Gianotti L, Nespoli L, Torselli L, Panelli M, Nespoli A. Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program. Int J Colorectal Dis. 2011;26(6):747–753. doi: 10.1007/s00384-011-1138-3.
    1. Hébuterne X, Lemarié E, Michallet M, Montreuil CB, Schneider SM, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. J Parenter Enteral Nutr. 2014;38(2):196–204. doi: 10.1177/0148607113502674.
    1. Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Constanza MC, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013;381(9864):385–393. doi: 10.1016/S0140-6736(12)61351-8.
    1. Herbert G, et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev. 2018;2018:10.
    1. Herbert G, et al. Early enteral nutrition within 24 hours of lower gastrointestinal surgery versus later commencement for length of hospital stay and postoperative complications. Cochrane Database Syst Rev. 2019;7(7):CD004080.
    1. Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268. doi: 10.1186/cc10546.
    1. Instituto Nacional de Câncer José Alencar Gomes da Silva . Consenso nacional de nutrição oncológica: volume II. Rio de Janeiro: INCA; 2016.
    1. Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care. 2010;19(3):261–268. doi: 10.4037/ajcc2010197.
    1. Lambert E, Carey S. Practice guideline recommendations on perioperative fasting: a systematic review. J Parenter Enteral Nutr. 2016;40(8):1158–1165. doi: 10.1177/0148607114567713.
    1. LeGall JR, Loirat P, Alpérovitch A. APACHE II: a severity of disease classification system. Crit Care Med. 1986;14(8):754–755.
    1. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152(3):292–298. doi: 10.1001/jamasurg.2016.4952.
    1. Maltby JR. Fasting from midnight: the history behind the dogma. Best Pract Res Clin Anaesthesiol. 2006;20(3):363–378. doi: 10.1016/j.bpa.2006.02.001.
    1. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and assessment of nutrition support therapy in the adult critically Ill patient: society of critical care medicine (SCCM) and american society for parenteral and enteral nutrition (A.S.P.E.N.) J Parenter Enteral Nutr. 2016;40(2):159–211. doi: 10.1177/0148607115621863.
    1. Mitchell CO, Lipschitz DA. Arm length measurement as an alternative to height in nutritional assessment of the elderly. J Parenter Enteral Nutr. 1982;6(3):226–229. doi: 10.1177/0148607182006003226.
    1. Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer. 2019;29(4):651–658. doi: 10.1136/ijgc-2019-000356.
    1. Osland E, Yunus RM, Khan S, Memon MA. Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. J Parenter Enteral Nutr. 2011;35(4):473–487. doi: 10.1177/0148607110385698.
    1. Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Ait Hssain A, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2) Lancet. 2018;391(10116):133–143. doi: 10.1016/S0140-6736(17)32146-3.
    1. Sandrucci C, Beets G, Braga M, Dejong K, Demartines N. Perioperative nutrition and enhanced recovery after surgery in GI cancer patients. A position paper by the ESSO task force in collaboration with the ERAS society (ERAS coalition) Eur J Surg Oncol. 2018;44(4):509–514. doi: 10.1016/j.ejso.2017.12.010.
    1. Shida D, Tagawa K, Inada K, et al. Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC Surg. 2017;17:1–6. doi: 10.1186/s12893-017-0213-2.
    1. Silva Fink J. Daniel de Mello P, Daniel de Mello E. Subjective global assessment of nutritional status – a systematic review of the literature. Clin Nutr. 2015;34(5):785–792. doi: 10.1016/j.clnu.2014.12.014.
    1. Silva JM, Jr, Malboulsson LMS, Nuevo HL, et al. Aplicabilidade do escore fisiológico agudo simplificado (SAPS 3) em hospitais brasileiros. Rev Bras Anestesiol. 2010;60(1):20–31. doi: 10.1016/S0034-7094(10)70003-9.
    1. Silva FR, Oliveira MG, Souza AS, Figueroa JN, Santos CS. Factors associated with malnutrition in hospitalized cancer patients: a croos-sectional study. Nutr J. 2015;14:123. doi: 10.1186/s12937-015-0113-1.
    1. Sogayar AM, Machado FR, Rea-Neto A, Dornas A, Grion CM, Lobo SM, et al. A multicentre, prospective study to evaluate costs of septic patients in Brazilian intensive care units. Pharmacoeconomics. 2008;26(5):425–434. doi: 10.2165/00019053-200826050-00006.
    1. Vallejo KP, Martínez CM, Matos Adames AA, Fuchs-Tarlovsky V, Nogales GCC, Paz RER, et al. Current clinical nutrition practices in critically ill patients in Latin America: a multinational observational study. Crit Care. 2017;21(1):227. doi: 10.1186/s13054-017-1805-z.
    1. van Zelm R, Coeckeberghs E, Semeus W, Wolthuis A, Bruyneel L, Panella M, Vanhaecht K. Effects of implementing a care pathway for colorectal cancer surgery in ten European hospitals: an international multicenter pre–post-test study. Updates Surg. 2020;72(1):61–71. doi: 10.1007/s13304-020-00706-9.
    1. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure: on behalf on the working group on sepsis-related problems of the european society of intensive care medicine. Intensive Care Med. 1996;22(7):707–710. doi: 10.1007/BF01709751.
    1. Vonlanthen R, Slankamenac K, Breitenstein S, Puhan MA, Muller MK, Hahnloser D, et al. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg. 2011;254(6):907–913. doi: 10.1097/SLA.0b013e31821d4a43.
    1. Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–650. doi: 10.1016/j.clnu.2017.02.013.
    1. Williams DGA, Molinger J, Wischmeyer PE. The malnourished surgery patient: a silent epidemic in perioperative outcomes? Curr Opin Anaesthesiol. 2019;32(3):405–411. doi: 10.1097/ACO.0000000000000722.
    1. Wischmeyer PE, Carli F, Evans DC, et al. American society for enhanced recovery and perioperative quality initiative joint consensus statement on nutrition screening and therapy within a surgical enhanced recovery pathway. Anesth Analg. 2018;126(6):1883–1895. doi: 10.1213/ANE.0000000000002743.
    1. Zampieri FG, Soares M, Borges LP, Salluh JIF, Ranzani OT. The epimed monitor ICU Database®: a cloud-based national registry for adult ICU patients in Brazil. Rev Bras Ter Intensiva. 2017;29(4):418–426. doi: 10.5935/0103-507X.20170062.
    1. Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care. 2016;20(1):367. doi: 10.1186/s13054-016-1538-4.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する