Assessment of the adherence to perioperative nutritional care protocols in Brazilian hospitals: The PreopWeek study

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Nutrition Pub Date : 2024-10-23 DOI:10.1016/j.nut.2024.112611

Maria Cristina Gonzalez M.D., Ph.D. , Thiago J.M. Gonçalves M.D., Ph.D. , Valéria A. Rosenfeld M.D. , Silvana P. Orlandi R.D., Ph.D. , Pedro E. Portari-Filho M.D., Ph.D. , Antonio Carlos L. Campos M.D., Ph.D.

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引用次数: 0

Abstract

Objectives

The study (PreopWeek) aimed to assess the perioperative nutritional care for major surgical patients in Brazilian hospitals, focusing on adherence to emerging multimodal protocols like Enhanced Recovery After Surgery and Acceleration of Total Postoperative Recovery.

Methods

An observational cross-sectional study was conducted in Brazilian hospitals enrolled voluntarily from June 19 to June 23, 2023 (convenience sample). Data were collected through patient interviews and medical records review.

Results

Data from 219 patients up to the fifth postoperative day or postoperative discharge across 24 hospitals were analyzed. Only three hospitals (12.5%) had established institutional perioperative protocols. Most of the patients were female (60.3%) and over 60 y old (81.7%) and underwent gastrointestinal (34.7%) or orthopedic (33.3%) surgeries. General and nutritional preoperative counseling was provided to a respective 82.2% and 62.6% of the patients. Only 25.7% of the patients had preoperative fasting for up to 3 h, and 28.8% received carbohydrate-rich supplements. Immunonutrition was not received by 43.8% at any point. Although most started postoperative refeeding within 24 h (81.7%), 39.4% started with a liquid diet and 70.6% reported postoperative immobilization in the first 24 h. Notable differences were observed between hospitals with and without protocols. Hospitals with institutional protocols reported significantly more preoperative exercises and nutritional counseling and higher adherence rates for all the perioperative protocols.

Conclusions

Our study demonstrates a lack of adherence to the multimodal protocols, even in hospitals with institutional protocols. Future educational programs are necessary to improve this result.

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评估巴西医院对围手术期营养护理方案的遵守情况：术前一周研究

研究目的该研究（PreopWeek）旨在评估巴西医院对重大手术患者的围手术期营养护理，重点关注新出现的多模式方案（如加强术后恢复和加速术后全面恢复）的遵守情况：一项观察性横断面研究于 2023 年 6 月 19 日至 6 月 23 日在自愿注册的巴西医院进行（方便抽样）。数据通过患者访谈和病历审查收集：分析了来自 24 家医院的 219 名患者截至术后第五天或术后出院的数据。只有三家医院（12.5%）制定了机构围手术期规范。大多数患者为女性（60.3%）和 60 岁以上（81.7%），接受胃肠道手术（34.7%）或骨科手术（33.3%）。分别有 82.2% 和 62.6% 的患者在术前接受了一般咨询和营养咨询。只有 25.7% 的患者在术前禁食长达 3 小时，28.8% 的患者接受了富含碳水化合物的补充剂。43.8%的患者在任何时候都没有接受免疫营养。虽然大多数患者在术后 24 小时内开始进食（81.7%），但有 39.4% 的患者在术后 24 小时内开始进食流质饮食，70.6% 的患者在术后 24 小时内固定不动。制定了制度规范的医院报告的术前运动和营养咨询明显更多，所有围手术期规范的遵守率也更高：结论：我们的研究表明，即使在有机构协议的医院，也缺乏对多模式协议的遵守。未来有必要开展教育计划来改善这一结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Nutrition 医学-营养学

CiteScore

7.80

自引率

2.30%

发文量

300

审稿时长

60 days

期刊介绍： Nutrition has an open access mirror journal Nutrition: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. Founded by Michael M. Meguid in the early 1980''s, Nutrition presents advances in nutrition research and science, informs its readers on new and advancing technologies and data in clinical nutrition practice, encourages the application of outcomes research and meta-analyses to problems in patient-related nutrition; and seeks to help clarify and set the research, policy and practice agenda for nutrition science to enhance human well-being in the years ahead.