Factors predictive of postoperative clinical outcomes in gastrointestinal surgical patients – A prospective observational study

Miss Karthika Narendra1, Dr Nicole Kiss1, Dr Claire Margerison1, Ms Belinda Johnston2, Ms Brooke Chapman2

1Deakin University, Burwood, Australia, 2Austin Health , Heidelberg, Australia

Abstract:

Aim:
Malnutrition is a highly prevalent condition in gastrointestinal (GI) surgical patients and has been linked to adverse clinical outcomes. The aim of this study is to determine the association between preoperative nutritional status and postoperative nutritional management with clinical outcomes.

Method:
A prospective observational study in GI surgical patients with a minimum three-day postoperative length of stay (PLOS). Data on patient demographics, nutritional status, postoperative nutritional management and clinical outcomes were collected. Four markers of nutritional status were assessed: preoperative weight loss, nutrition risk, nutritional status and handgrip strength (HGS). Multiple linear regression and multivariate logistic regression were used to test for association with PLOS and complications.

Results:
115 patients (55% female, mean age 60.8 ±16.2 years) were included. The median PLOS was 8.0 days with 37% of participants developing at least one complication postoperatively. All four markers of nutritional status independently predicted longer PLOS (all p<0.05). The average time taken to commence feeding (solids, enteral or parenteral nutrition) was 3.3 ± 2.2 days. The mean number of nil-by mouth (NBM) days was 0.7 ± 1.2, though ranged from 0-7 days. No significant association was found between time to commence feeding or number of NBM days, and clinical outcomes.

Significance of the findings to allied health:
All four nutritional markers assessed in this study predicted longer PLOS in patients undergoing GI surgery, facilitating simple identification of patients at high priority for dietetic intervention. This study highlights that delayed and varied feeding practices remain and may exacerbate postoperative nutritional decline.

Biography:

Karthika is a dietetics graduate who completed her honours year at Deakin University in 2018. Following the completion of her studies, she hopes to embark on her career as a clinical dietitian.