Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery
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RESEARCH
Open Access
Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery David G. A. Williams1,2, Tetsu Ohnuma1, Vijay Krishnamoorthy1, Karthik Raghunathan1, Suela Sulo3, Bridget A. Cassady3, Refaat Hegazi3 and Paul E. Wischmeyer1,2*
Abstract Background: Small randomized trials of early postoperative oral nutritional supplementation (ONS) suggest various health benefits following colorectal surgery (CRS). However, real-world evidence of the impact of early ONS on clinical outcomes in CRS is lacking. Methods: Using a nationwide administrative-financial database (Premier Healthcare Database), we examined the association between early ONS use and postoperative clinical outcomes in patients undergoing elective open or laparoscopic CRS between 2008 and 2014. Early ONS was defined as the presence of charges for ONS before postoperative day (POD) 3. The primary outcome was composite infectious complications. Key secondary efficacy (intensive care unit (ICU) admission and gastrointestinal complications) and falsification (blood transfusion and myocardial infarction) outcomes were also examined. Propensity score matching was used to assemble patient groups that were comparable at baseline, and differences in outcomes were examined. Results: Overall, patients receiving early ONS were older with greater comorbidities and more likely to be Medicare beneficiaries with malnutrition. In a well-matched sample of early ONS recipients (n = 267) versus non-recipients (n = 534), infectious complications were significantly lower in early ONS recipients (6.7% vs. 11.8%, P < 0.03). Early ONS use was also associated with significantly reduced rates of pneumonia (P < 0.04), ICU admissions (P < 0.04), and gastrointestinal complications (P < 0.05). There were no significant differences in falsification outcomes. Conclusions: Although early postoperative ONS after CRS was more likely to be utilized in elderly patients with greater comorbidities, the use of early ONS was associated with reduced infectious complications, pneumonia, ICU admission, and gastrointestinal complications. This propensity score-matched study using realworld data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients. Keywords: Health outcomes, Nutrition, Surgery, Oral nutrition supplement, Malnutrition, Postoperative, Colorectal surgery, Infection, Pneumonia, ICU
* Correspondence: [email protected] 1 CAPER Unit, Department of Anesthesiology, Duke University School of Medicine, DUMC, Box 3094 Mail # 41, 2301 Erwin Road, 5692 HAFS, Durham, NC 27710, USA 2 Duke Clinical Research Institute, Durham, NC, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the orig
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