Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol
Reduced length of stay in radical cystectomy patients with oral versus parenteral post-operative nutrition protocol
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DOI：
10.1007/s11096-015-0072-9
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发表时间：
2015-04-01
影响因子：
2.4
通讯作者：
Isabel, Spriet
中科院分区：
文献类型：
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作者：
Declercq, Peter;De Win, Gunter;Isabel, Spriet
背景在欧洲，肠外营养常用于根治性膀胱切除术后，以避免术后营养不良。据我们所知，然而，有一个缺乏的数据，以得出结论的最佳方式提供营养支持，这一患者群体。目的重新考虑肠外营养政策，由临床药师实施口服营养方案，并从住院时间、术后并发症的数量和类型以及肠外营养避免的费用方面进行评估。背景进行了一项前瞻性干预性非随机前后研究。术前无肠内营养禁忌症的常规根治性膀胱癌患者符合条件。方法对照组术后由病房提供肠外营养支持。系统地开始肠外营养，并持续到患者能够耐受固体食物。在干预组中，实施口服营养方案。如果5天后口服摄入量仍然不足，可以开始肠外营养。主要观察指标：术后住院时间。次要终点包括成功实施口服营养方案的患者数量，以及术后并发症的数量和类型。结果94例患者随机分为对照组（n = 48）和干预组（n = 46）。基线人口统计学数据具有可比性。中位住院时间的显著缩短与口服营养方案相关[对照组为18天（IQR 15 - 22），干预组为14天（IQR 13 - 18）（p <0.001）]。干预组46例患者中有40例成功实施了口服营养方案。术后并发症的数量和类型没有显著差异。实施口服营养方案导致每例患者直接肠外营养输液袋成本节省约a，而不是sign512，住院费用减少a，而不是sign2，608。结论：我们的研究结果表明，口服营养方案，与系统的术后使用肠外营养相比，与减少住院时间和费用在常规根治性膀胱癌患者人群。
Background In Europe, parenteral nutrition is often used after radical cystectomy to avoid postoperative malnourishment. To the best of our knowledge, however, there is a paucity of data to conclude on the best modality for delivering nutritional support to this patient group. Objective The parenteral nutrition policy was reconsidered and an oral nutrition protocol was implemented by the clinical pharmacist and evaluated in terms of length of stay, number and type of postoperative complications and parenteral nutrition avoided costs. Setting A prospective interventional non-randomized before-after study was conducted. Regular radical cystectomy patients presenting without preoperative contra-indications for enteral nutrition were eligible. Methods Postoperatively, in the control group, the parenteral nutrition policy from the ward was applied. Parenteral nutrition was initiated systematically and continued until the patient was able to tolerate solid food. In the interventional group, an oral nutrition protocol was implemented. Parenteral nutrition could be initiated if oral intake remained insufficient after 5 days. Main outcome measure The primary end point was postoperative length of stay. Secondary endpoints included the number of patients in whom the oral nutrition protocol was implemented successfully, as well as the number and type of postoperative complications. Results A total of 94 eligible patients was assigned consecutively to the control (n = 48) and to the interventional group (n = 46). Baseline demographics were comparable. A significant reduction in median length of stay was associated with the oral nutrition protocol [18 days (IQR 15-22) in the control group vs. 14 days (IQR 13-18) in the interventional group (p < 0.001)]. In 40 out of 46 patients from the interventional group, the oral nutrition protocol was implemented successfully. The number and type of postoperative complications did not differ significantly. Implementing the oral nutrition protocol resulted in a direct parenteral nutrition infusion bag cost saving of approximately a,not sign512 and a reduction in hospitalization cost of a,not sign2,608 per patient. Conclusion The findings of our study showed that an oral nutrition protocol, when compared to the systematic postoperative use of parenteral nutrition, was associated with a decreased length of stay and costs in a regular radical cystectomy patient population.