Nutritional risk predicts postoperative complications and length of stay, whereas sarcopenia risk predicts need for step-down care in a mixed elective surgery population.

BACKGROUND: Malnutrition and poor functional reserves place patients at risk for negative surgical outcomes. In this prospective study we aimed to measure preoperative nutritional and sarcopenia risk and evaluate their impact on postoperative outcomes. METHODS: Adults scheduled to undergo elective general and gastrointestinal surgery were screened for nutrition risk using the Malnutrition Universal Screening Tool screening tool. Sarcopenia risk was measured using the SARC-F tool and hand-grip strength. Patients were followed postoperatively. Incidence of complications, length of stay (LOS), readmission rates, and need for step-down care were recorded. RESULTS: One hundred and twenty-two patients were included. Mean age was 53.8 years (standard deviation [SD] 16.44). Sixty-six (54%) were scheduled for day-case procedures, and 56 (46%) for nonday-case procedures. About 18.9% (n = 23) were at nutritional risk preoperatively. Ten patients (8.2%) had probable sarcopenia based on SARC-F, whereas seven (5.7%) had measurably reduced HG. Incidence of postoperative complications was 23.8% (n = 29). Nutrition risk was associated with the development of complications (p = 0.018). In the nonday-case group, nutritional risk was associated with greater LOS (p = 0.013). Older age was associated with need for step-down care (p = 0.002) as was SARC-F (p = 0.003). CONCLUSIONS: Preoperative nutritional screening can predict postoperative complications and LOS, whereas sarcopenia screening is predictive of the need for step-down care after discharge. Screening tools are quick and inexpensive and could provide valuable information to clinicians and allow patients the opportunity to enhance their physical preparedness for surgery thereby mitigating their risk for negative surgical outcomes.

Assessing appropriateness of parenteral nutrition usage in an acute hospital.

BACKGROUND: Although parenteral nutrition (PN) has become an integral component of patient care, the risks and costs associated with this therapy must be weighed against the benefits. The Department of Nutrition and Dietetics at our tertiary referral, university-affiliated hospital has audited the use of enteral nutrition and PN based on criteria devised from guidelines developed by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). We aimed to examine the use of PN over time and in particular to investigate the appropriate and inappropriate use of this feeding method. MATERIALS AND METHODS: Each patient referred for PN was assessed by a dietitian and need for PN evaluated. The appropriateness of the PN was categorized according to predefined criteria. RESULTS: A total of 1191 patients had 1409 episodes of PN during the study period. According to the predefined criteria, 82% of PN episodes were considered "appropriate." PN was "appropriate but avoidable" in 13% of cases. In 5% of episodes, the commencement of PN was considered "inappropriate." The use of appropriate PN increased significantly over the study period (P = .018). CONCLUSION: Most PN episodes were deemed appropriate. We saw 5% inappropriate usage, which is lower than reported in comparable studies. This study underlines the importance of continuous audit and evaluation of practice to maintain appropriate and evidence-based practice in nutrition support.