Pre- and postoperative nutritional status and dietary intake in patients undergoing gastroenterological surgery at St. Olavs Hospital
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Introduction and aim: The prevalence of malnutrition in hospital ranges between 10%-60%. Patients undergoing gastrointestinal surgery are at risk for malnutrition both because of insufficient food intake pre- and/or postoperatively and because of stress from surgery with following increased metabolism. Malnutrition in surgery has been found to be an independent risk factor affecting the postoperative outcome negatively. Finding suitable, validated and standardized methods to screen for malnutrition risk is an essential step towards improving perioperative nutritional status. The aim of this study was to describe nutritional status and diet before gastroenterological surgery and one month after surgery, and to compare the use of two nutritional screening tools in predicting postoperative outcome. Method: This was a prospective observational study recruiting patients from preoperative outpatient clinic before upper- or lower gastrointestinal surgery. At the outpatient clinic, patients were screened with the two nutritional screening tools NRS-2002 and PG-SGA. Postoperative outcomes, such as complications and length of hospital stay, were registered. The predictive value of nutritional risk (NRS-2002) and malnutrition (PG-SGA) on complications and LOS was evaluated using univariate and multivariate regression analyses. Dietary intake was assessed before surgery at the outpatient clinic, and one month after surgery over phone, using 24 h recall method. Results: The study recruited 101 surgical patients with a mean BMI of 26±5 kg/m2 and mean age of 60±17 years. NRS-2002 identified 24 % at nutritional risk and PG-SGA identified 28 % as malnourished. The impact of nutritional risk (NRS-2002) on the likelihood of postoperative complications recorded an OR of 2.71 (95% CI: 0.95-7.73; p=0.063) and nutritional status (PGSGA) recorded an OR of 2.03 (95% CI: 0.73-5.68; p=0.176). The respective adjusted effect recorded an OR of 3.88 (95% CI: 1.07-14.06; p= 0.039) and 3.07 (95% CI: 0.90-10.54; p=0.075), respectively. Neither of the two screening tools contributed significant in predicting length of hospital stay. Overall, mean energy- and protein intake did not differ significant pre- and postoperatively. Patients at risk or malnourished consumed significant less energy and protein before surgery compared to one-month after surgery. Conclusion: Two screening tools revealed that nutritional risk and malnutrition are frequent in patients before gastrointestinal surgery, even in a population with average BMI indicating overweight. NRS-2002 defining patients at risk presented the strongest predictor of complications in the adjusted analysis controlling for age, surgery, and co-morbidities.