Cribado nutricional en pacientes quirúrgicos en un hospital universitario / Nutritional screening in surgical patients at a university hospital

Objetivo: conocer la prevalencia de riesgo de desnutrición de los pacientes quirúrgicos hospitalizados de un hospital de tercer nivel. Método: estudio descriptivo transversal unicéntrico con pacientes quirúrgicos hospitalizados. Se realizó un cálculo de tamaño muestral de 323 pacientes y se reclutaron por conveniencia. Se analizó el riesgo de desnutrición con la escala Nutrition Risk Screening 2002 y su asociación con diferentes variables sociodemográficas y clínicas. Para el análisis de datos se aplicaron las pruebas de Chi cuadrado, prueba exacta de Fisher, t de Student y U de Mann Whitney con una significancia estadística de p< 0,05. Resultados: participaron 318 pacientes, de los cuales el 74,8% era hombre, con una edad media de 62,2 años (DE: 15,54). En el cribado inicial, 80 participantes (25,2%) presentaron riesgo potencial de desnutrición mientras que tras el screening final, solo 12 presentaron riesgo de desnutrición real (3,8%). No se halló relación entre la desnutrición y el sexo aunque sí con la edad, aumentando el riesgo proporcionalmente (p< 0,001). Otros factores asociados fueron la necesidad de un cuidador/a (p= 0,001), el tipo de patología de ingreso (p= 0,034) y tener antecedentes personales oncológicos (p< 0,001) y de deterioro cognitivo (p= 0,001). Conclusiones: la prevalencia de desnutrición en pacientes quirúrgicos hospitalizados es baja y parece que aumenta con la edad, y con antecedentes personales de deterioro cognitivo y enfermedad neoplásica, aunque los resultados deben ser interpretados con cautela. Identificar la presencia de desnutrición al ingreso favorece el fomento de medidas de prevención que permitan implementar un plan nutricional y facilitar el seguimiento tras el alta.(AU)

Objectives: to understand the prevalence of the risk of malnutrition among hospitalized surgical patients in a tertiary hospital. Method: a descriptive cross-sectional single-centre study with hospitalized surgical patients. The sample size was calculated at 323 patients, and there was convenience recruitment. The malnutrition risk was analysed with the Nutrition Risk Screening 2002 scale, and its association with different sociodemographic and clinical variables. The Chi Square, Fisher’s Exact, Student’s t and Mann-Whitney tests were applied for data analysis, with a statistical significance of p< 0.05. Results: the study included 318 patients; 74.8% of them were male, with a mean age of 62.2 years (SD: 15.54). At the initial screening, 80 participants (25.2%) presented potential risk of malnutrition; while after the final screening, only 12 presented a real risk of malnutrition (3.8%). No relationship was found between malnutrition and gender, but it was found with age, with a proportional increase in risk (p< 0.001). Other factors associated were the need for a caregiver (p= 0.001), the type of condition at admission (p= 0.034) and having a personal background of neoplasia (p< 0.001) and cognitive deterioration (p= 0.001). Conclusions: there is a low prevalence of malnutrition among hospitalized surgical patients, and it seems to increase with age and with a personal history of cognitive deterioration and neoplasia, although these results must be interpreted with caution. The detection of malnutrition at admission will promote taking prevention measures, therefore allowing to implement a nutritional plan and facilitating follow-up after discharge.(AU)

Manejo multidisciplinar y optimización del paciente oncofrágil o de elevado riesgo quirúrgico en cirugía del cáncer colorrectal. Análisis observacional prospectivo / Multidisciplinary management and optimization of frail or high surgical risk patients in colorectal cancer surgery: Prospective observational análisis

INTRODUCCIÓN: La fragilidad se asocia con una mayor morbimortalidad postoperatoria. El manejo multidisciplinar individualizado de estos pacientes puede mejorar la calidad asistencial. Los objetivos de este trabajo son conocer el porcentaje de pacientes frágiles con cáncer colorrectal en nuestra población y describir la morbimortalidad asociada a la cirugía y la evolución del tratamiento paliativo. MÉTODOS: Estudio observacional prospectivo de pacientes con cáncer colorrectal quirúrgico (1 de febrero del 2018-30 de abril del 2019). Cribado de paciente frágil y clasificación según grados de fragilidad. Decisión terapéutica (cirugía o tratamiento paliativo) según grado de fragilidad y voluntades explícitas del paciente. Análisis de comorbilidad postoperatoria (según Clavien-Dindo y Comprehensive Complication Index), mortalidad y seguimiento oncológico. RESULTADOS: Fueron visitados 193 pacientes con cáncer colorrectal quirúrgico, con una edad media de 74 años (44-92). Cribado: 46 pacientes frágiles (24%), con una edad media de 80 años (57-92). Se optimizó e intervino a 22 pacientes (48%), con una edad media de 78 años (57-89). Efectos adversos relevantes del 27,7% (4 efectos adversos grado iva, uno ivb y otro V, según Clavien-Dindo). Comprehensive Complication Index de 17,5. Tratamiento paliativo en 24 pacientes (52%), con una edad media de 82 años (59-92). Seguimiento medio de 7,8 meses, 2 muertes por progresión de la enfermedad (8,3%), 5 reconsultas por complicaciones del cáncer colorrectal (20,1%). CONCLUSIONES: El manejo multidisciplinar e individualizado del paciente frágil con cáncer colorrectal es clave para mejorar la calidad asistencial en el tratamiento de este grupo de pacientes

INTRODUCTION: Frailty is associated with greater postoperative morbidity and mortality. Individualized multidisciplinary management of these patients can improve the quality of care. The objectives of this study are to determine the percentage of frail patients with colorectal cancer in our population, and to describe the morbidity and mortality associated with surgery and the evolution of palliative treatment. METHODS: A prospective, observational study of patients with surgical colorectal cancer (February 1, 2018-April 30, 2019). Frail patients were screened and classified according to degrees of frailty. Therapeutic decision-making (surgery or palliative treatment) was determined by the degree of fragility and explicit will of the patient. Postoperative comorbidities were analyzed (according to Clavien-Dindo and Comprehensive Complication Index), as were mortality and oncological follow-up. RESULTS: The study included 193 patients with surgical colorectal cancer, with a mean age of 74 years (44-92). Screening identified 46 frail patients (24%), with a mean age of 80 years (57-92). Twenty-two patients were optimized and underwent surgery (48%), with a mean age of 78 years (57-89). Relevant adverse effect rate was 27.7% (4 grade iva adverse effects, one ivb and one V, according to Clavien-Dindo). Comprehensive Complication Index was 17.5. Palliative treatment was administered in 24 patients (52%), with a mean age of 82 years (59-92). Mean follow-up was 7.8 months. There were 2 deaths due to disease progression (8.3%), 5 re-consultations due to complications of colorectal cancer (20.1%). CONCLUSIONS: The multidisciplinary and individualized management of frail patients with colorectal cancer is key to improve the quality of care in the treatment of this patient group

Multidisciplinary management and optimization of frail or high surgical risk patients in colorectal cancer surgery: Prospective observational analysis. / Manejo multidisciplinar y optimización del paciente oncofrágil o de elevado riesgo quirúrgico en cirugía del cáncer colorrectal. Análisis observacional prospectivo.

INTRODUCTION: Frailty is associated with greater postoperative morbidity and mortality. Individualized multidisciplinary management of these patients can improve the quality of care. The objectives of this study are to determine the percentage of frail patients with colorectal cancer in our population, and to describe the morbidity and mortality associated with surgery and the evolution of palliative treatment. METHODS: A prospective, observational study of patients with surgical colorectal cancer (February 1, 2018-April 30, 2019). Frail patients were screened and classified according to degrees of frailty. Therapeutic decision-making (surgery or palliative treatment) was determined by the degree of fragility and explicit will of the patient. Postoperative comorbidities were analyzed (according to Clavien-Dindo and Comprehensive Complication Index), as were mortality and oncological follow-up. RESULTS: The study included 193 patients with surgical colorectal cancer, with a mean age of 74 years (44-92). Screening identified 46 frail patients (24%), with a mean age of 80 years (57-92). Twenty-two patients were optimized and underwent surgery (48%), with a mean age of 78 years (57-89). Relevant adverse effect rate was 27.7% (4 grade iva adverse effects, one ivb and one v, according to Clavien-Dindo). Comprehensive Complication Index was 17.5. Palliative treatment was administered in 24 patients (52%), with a mean age of 82 years (59-92). Mean follow-up was 7.8 months. There were 2 deaths due to disease progression (8.3%), 5 re-consultations due to complications of colorectal cancer (20.1%). CONCLUSIONS: The multidisciplinary and individualized management of frail patients with colorectal cancer is key to improve the quality of care in the treatment of this patient group.