Protein intakes reduce length of stay after elective colorectal surgery
The inclusion of oral nutrition supplements increases protein consumption of patients receiving Enhanced Recovery After Surgery (ERAS) protocols, but total protein intake remains insufficient to meet recommendations, according to a study.
Furthermore, the length of hospital stay (LOS) is independently predicted by consumption of ≥60 percent protein needs after surgery and Malnutrition Screening Tool (MST) scores.
Researchers conducted a prospective cohort study to compare protein adequacy, energy intakes, gut function and clinical outcomes, and how well nutritional variables predict LOS in adult elective colorectal resection patients receiving conventional (n=46) and ERAS (n=69) care.
Data on preoperative MST score, 3-day food records, postoperative nausea, LOS and complications were obtained. Researchers performed multivariable regression analysis to investigate whether low protein intakes and the MST score were predictive of LOS.
ERAS patients had significantly higher total protein intakes due to the inclusion of oral nutrition supplements compared with those receiving conventional care (0.54 g/kg−1/d− 1 vs 0.33 g/kg−1/d− 1; p<0.02). A multivariable model that controlled for differences between baseline and surgical variable showed that the group difference in protein intake was maintained (p=0.001). There were no between-group difference in terms of oral food intake.
There were shorter LOS and fewer total infectious complications in ERAS patients (p=0.049 and p=0.01, respectively). Nausea was predictive of protein intake. After controlling for potential confounders, the independent predictors of earlier discharge were nutrition variables.
Each unit increase in preoperative MST score was associated with longer LOS of 2.5 days (95 percent CI, 1.5 to 3.5; p<0.001), and the consumption of ≥60 percent of protein requirements during the first 3 days of hospitalization predicted shorter LOS of 4.4 days (‒6.8 to ‒2.0; p<0.001).
“Protein can modulate the surgical stress response and postoperative catabolism,” researchers said, adding that “ERAS protocols are evidence-based care bundles that reduce morbidity.”