Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery

Lisa Martin; Chelsia Gillis; Marlis Atkins; Melani Gillam; Caroline Sheppard; Sue Buhler; Carlota Basualdo Hammond; Gregg Nelson; Leah Gramlich

doi:10.1002/jpen.1417

Implementation of an Enhanced Recovery After Surgery Program Can Change Nutrition Care Practice: A Multicenter Experience in Elective Colorectal Surgery

JPEN J Parenter Enteral Nutr. 2019 Feb;43(2):206-219. doi: 10.1002/jpen.1417. Epub 2018 Jul 23.

Authors

Lisa Martin¹, Chelsia Gillis², Marlis Atkins³, Melani Gillam⁴, Caroline Sheppard⁵, Sue Buhler³, Carlota Basualdo Hammond³, Gregg Nelson⁶, Leah Gramlich^{1

7}

Affiliations

¹ Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
² Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
³ Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada.
⁴ Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada.
⁵ Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada.
⁶ Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
⁷ Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.

PMID: 30035814
DOI: 10.1002/jpen.1417

Abstract

Background: Enhanced recovery after surgery (ERAS) programs are multimodal evidenced-based care pathways for optimal recovery. Central to ERAS is integration of perioperative nutrition care into the overall management of the patient. This study describes changes to perioperative nutrition care after implementation of an ERAS program, and identifies factors that affect compliance to ERAS care elements and short-term postoperative outcomes.

Methods: Data were prospectively collected from patients undergoing elective colorectal surgery at 6 hospitals in Alberta, Canada, from 2013-2017. Compliance to nutrition care elements (nutrition risk screening, preoperative carbohydrate loading, early postoperative oral feeding, and mobilization) was recorded before ERAS implementation (pre-ERAS group, n = 487) and with ERAS implementation (ERAS group, n = 3536). Logistic regression identified factors that affect compliance to care elements, length of hospital stay (LOS), and postoperative complications.

Results: A total of 4023 patients were included. The rate of nutrition risk screening improved from 9% (pre-ERAS group) to 74% (ERAS group); 12% were at nutrition risk. Compliance increased for preoperative carbohydrate loading (4%-61%), early postoperative oral feeding (P < .001), and mobilization (P < .001). In multivariable logistic regression, nutrition risk independently predicted low overall compliance (<70%) to ERAS care elements (odds ratio [OR] 2.77; 95% CI, 2.11-3.64; P < .001) and a trend for LOS >5 days (OR 1.40; 95% CI, 1.00-1.96; P = .052). Low compliance to ERAS (<70%) predicted postoperative complications (OR 2.69; 95% CI, 2.23-3.24; P < .001).

Conclusion: ERAS implementation positively impacted the adoption of standardized perioperative nutrition care practices. Nutrition risk screening identified patients less able to comply with postoperative nutrition care elements and who had longer LOS.

Keywords: compliance; elective colorectal surgery; enhanced recovery after surgery; nutrition risk screening; perioperative nutrition care.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Colorectal Surgery*
Elective Surgical Procedures*
Enhanced Recovery After Surgery*
Female
Humans
Male
Middle Aged
Nutrition Therapy / methods*
Postoperative Complications / prevention & control*
Prospective Studies
Young Adult