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In Hospital Nutritional Intake in Patients Undergoing Elective Esophagogastric Resection
Melanie L. Baker1, Vanessa Halliday2, Anne Thomas3, Robert Williams1, David Bowrey*1
1Surgery, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom; 2Health Sciences, University of Sheffield, Sheffield, United Kingdom; 3University of Leicester, Leicester, United Kingdom
Background
There is a little information about nutritional status after esophagogastric resection in the literature. Information on nutritional status at baseline and discharge from hospital after surgery was evaluated in patients enrolled in a randomized controlled trial of home enteral feeding versus standard care.
Methods
A postoperative jejunal feeding protocol of water 20 ml/hr (day 1), polymeric feed 20 ml/hr (day 2), increasing by 20 ml/hr/day (day 3 onwards) until target. A reduced feeding rate was employed if inotropic support was needed (intensive care unit), or gastrointestinal side effects occurred (ward). Feeding was 24 hrs daily until oral intake recommenced, then overnight until hospital discharge. Nutritional intake was assessed using a 3 day dietary record prior to discharge, analysed using Dietplan6®. Ideal nutritional requirements for energy (Henry equation adjusted for stress/activity) and protein (1.25g/kg/day) were calculated for weight maintenance.
Results
The sample was 42 patients (34 male) of mean age 64 years (range 44 to 77), undergoing esophagectomy (n=32) or total gastrectomy (n=10). Mean hospital stay was 18 days. Mean preoperative BMI was 28 kg/m2. Overall mean jejnual intake was 1010 kcal (SD 227kcal) and 44g protein (SD 11g) throughout hospital stay, representing 51% and 47% of estimated requirements respectively. The mean time to achieve a final feeding rate was 8 days (SD 2). Eight participants (19%) did not meet their estimated requirement before switching to overnight feeding. Adherence to the care pathway for feeding was 35/42 (83%). The mean % weight change in hospital was -3% (range -13% to +7%). 24% of subjects lost >5% of body weight, with 5% losing >10% weight. Mean change in Hand grip strength was -2.3kg (range -16.8 to 8.3) and mid arm muscle circumference reduced by 1.2cm (range -16.8 to 8.3). Dietary records indicated a mean total energy intake of 2250 kcal daily (1270 kcal jejunal, 980 kcal oral). Of estimated requirement, these represented 64% (jejunal) & 50% (oral) for energy, and 60% (JEJ) & 33% (oral) for protein respectively.
Conclusions
In spite of using a care pathway of standard jejunostomy feeding after esophagogastric resection, overall nutritional intake during hospital stay was inadequate to meet estimated requirements for both energy and protein. These findings support the need to fully evaluate extended enteral nutrition in this setting.
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