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    Journal Reading Mira

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    Ari Pandita
    This document describes a study that implemented an enhanced recovery after surgery (ERAS) protocol with a focus on nutritional support for patients undergoing head and neck cancer surgery. The study aimed to improve outcomes by providing standardized pre- and post-operative nutritional interventions. As part of the ERAS protocol, patients received oral nutritional supplements before surgery, enteral tube feeding after surgery, and were discharged home with continued enteral or oral nutrition support. Outcome variables like complication rates were compared to a previous cohort of patients who did not receive the ERAS protocol. The results showed that implementing a standardized nutrition protocol as part of ERAS care improved nutritional status and may help reduce complications associated with surgery.

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    Journal Reading Mira

    Uploaded by

    Ari Pandita
    10 views14 pages
    This document describes a study that implemented an enhanced recovery after surgery (ERAS) protocol with a focus on nutritional support for patients undergoing head and neck cancer surgery. The study aimed to improve outcomes by providing standardized pre- and post-operative nutritional interventions. As part of the ERAS protocol, patients received oral nutritional supplements before surgery, enteral tube feeding after surgery, and were discharged home with continued enteral or oral nutrition support. Outcome variables like complication rates were compared to a previous cohort of patients who did not receive the ERAS protocol. The results showed that implementing a standardized nutrition protocol as part of ERAS care improved nutritional status and may help reduce complications associated with surgery.

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    This document describes a study that implemented an enhanced recovery after surgery (ERAS) protocol with a focus on nutritional support for patients undergoing head and neck cancer surgery. The study aimed to improve outcomes by providing standardized pre- and post-operative nutritional interventions. As part of the ERAS protocol, patients received oral nutritional supplements before surgery, enteral tube feeding after surgery, and were discharged home with continued enteral or oral nutrition support. Outcome variables like complication rates were compared to a previous cohort of patients who did not receive the ERAS protocol. The results showed that implementing a standardized nutrition protocol as part of ERAS care improved nutritional status and may help reduce complications associated with surgery.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    10 views14 pages

    Journal Reading Mira

    Uploaded by

    Ari Pandita
    This document describes a study that implemented an enhanced recovery after surgery (ERAS) protocol with a focus on nutritional support for patients undergoing head and neck cancer surgery. The study aimed to improve outcomes by providing standardized pre- and post-operative nutritional interventions. As part of the ERAS protocol, patients received oral nutritional supplements before surgery, enteral tube feeding after surgery, and were discharged home with continued enteral or oral nutrition support. Outcome variables like complication rates were compared to a previous cohort of patients who did not receive the ERAS protocol. The results showed that implementing a standardized nutrition protocol as part of ERAS care improved nutritional status and may help reduce complications associated with surgery.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 14

    JOURNAL READING

    Mira D. Prawira
    INTRODUCTION

    • Enhanced recovery after surgery (ERAS) is a multidisciplinary,


    evidence-based practice that targets perioperative care to optimize
    postoperative outcomes.
    • Introduction of the ERAS protocol in head and neck surgery is
    promising given the extensive and complex procedures performed.
    • The primary site of tumor involvement and tumor extent contributes to
    severity of dysphagia and resultant malnutrition.
    PURPOSES

    • To design and implement the nutritional aspect of a multimodal ERAS protocol


    to improve quality of care in patients with HNC by demonstrating the
    feasibility of our protocol.
    • To show the impact on head and neck surgery patient outcomes after
    implementation of protocols where our patient cohort received standardized
    preoperative and post- operative nutritional support.
    METHODS

    • A waiver was obtained from the University of Mississippi Medical


    Center institutional review board for this quality improvement (QI)
    study.
    • Preoperative nutritional assessment (2 weeks before
    surgery)
    • ONS 3 times daily for 2 weeks before surgery
    • Preoperative lab test (CRP, Albumin, Prealbumin,
    TSH)
    • A second nutritional assessment (Via telp) – 1 week
    before surgery
    NUTRITIONAL • On the day of surgery, patients submitted their ONS
    PROTOCOL record for compliance assessment.
    • Enteral nutrition with IMPACT Peptide 1.5 (Nestle`
    Health Science) started at 6 AM on the first post-
    operative day.
    • Patients were discharged home with tube feeding or
    ONS depending on their swallowing function or
    surgical reconstruction for a minimum of 2 weeks.
    STUDY
    POPULATION

    • Prospective cohort
    • Surgery occurred between July 1,2018
    and June, 30 2019.
    • Patients under the age of 18 were also
    excluded
    • For comparison purposes, 25 patients
    who underwent surgery between July 1,
    2017, and June 30, 2018, and were case
    matched regarding tumor site, tumor
    stage, demographics, and procedure
    performed were used.
    • Age
    • Sex
    • Height
    • Current weight, Usual weight, weight 6 months prior
    • Consistency of oral intake
    • Functional status

    VARIABLES • Cancer site and stage


    • Tobacco use
    • Previous radiation treatment
    • Preoperative laboratory values (CRP. TSH, Albumin,
    prealbumin)
    • Body mass index (BMI), percentage of weight loss in the past 6
    months, and modified Nutrition-Related Index (mNRI) were
    calculated and used in the analysis.
    PRE-ENHANCED RECOVERY AFTER
    SURGERY
    ENHANCED RECOVERY AFTER SURGERY

    Prealbumin level <10 : 3 packets/d


    mRNI = (1.519 x serum albumin)
    Prealbumin level 10-15 : 2 packets/d
    + (41.7x (mass.ideal body weight)
    Prealbumin level >15-20 : 1packet/d
    RESULTS
    DISCUSSION

    • Patients with poor nutritional status are more likely to have increased
    complications, specifically, fistulas and unplanned reoperations.
    • A higher fistula rate was previously shown in patients with hypoalbuminemia.
    • Albumin levels obtained either preoperatively or on the day of surgery
    correlate with increased complications and increased length of hospital stay.
    DISCUSSION
    IMPLICATIONS FOR PRACTICE

    • Malnourished patients have higher rates of perioperative com- plications.


    • ERAS nutrition protocols improve individualized patient-directed care and may decrease
    complications associated with health care costs.
    • Quality improvement processes demand frequent reassessment and modification to ensure
    the most efficient and targeted approach to improving patient care.
    THANKYOU

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