Cargando…
Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery
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 administra...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534158/ https://www.ncbi.nlm.nih.gov/pubmed/33029348 http://dx.doi.org/10.1186/s13741-020-00160-6 |
_version_ | 1783590262957670400 |
---|---|
author | Williams, David G. A. Ohnuma, Tetsu Krishnamoorthy, Vijay Raghunathan, Karthik Sulo, Suela Cassady, Bridget A. Hegazi, Refaat Wischmeyer, Paul E. |
author_facet | Williams, David G. A. Ohnuma, Tetsu Krishnamoorthy, Vijay Raghunathan, Karthik Sulo, Suela Cassady, Bridget A. Hegazi, Refaat Wischmeyer, Paul E. |
author_sort | Williams, David G. A. |
collection | PubMed |
description | 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 real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients. |
format | Online Article Text |
id | pubmed-7534158 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-75341582020-10-06 Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery Williams, David G. A. Ohnuma, Tetsu Krishnamoorthy, Vijay Raghunathan, Karthik Sulo, Suela Cassady, Bridget A. Hegazi, Refaat Wischmeyer, Paul E. Perioper Med (Lond) Research 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 real-world data suggests that clinical outcomes are improved with early ONS use, a simple and inexpensive intervention in CRS patients. BioMed Central 2020-10-05 /pmc/articles/PMC7534158/ /pubmed/33029348 http://dx.doi.org/10.1186/s13741-020-00160-6 Text en © The Author(s) 2020 Open AccessThis 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 original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Williams, David G. A. Ohnuma, Tetsu Krishnamoorthy, Vijay Raghunathan, Karthik Sulo, Suela Cassady, Bridget A. Hegazi, Refaat Wischmeyer, Paul E. Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
title | Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
title_full | Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
title_fullStr | Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
title_full_unstemmed | Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
title_short | Impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
title_sort | impact of early postoperative oral nutritional supplement utilization on clinical outcomes in colorectal surgery |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534158/ https://www.ncbi.nlm.nih.gov/pubmed/33029348 http://dx.doi.org/10.1186/s13741-020-00160-6 |
work_keys_str_mv | AT williamsdavidga impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT ohnumatetsu impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT krishnamoorthyvijay impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT raghunathankarthik impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT sulosuela impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT cassadybridgeta impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT hegazirefaat impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery AT wischmeyerpaule impactofearlypostoperativeoralnutritionalsupplementutilizationonclinicaloutcomesincolorectalsurgery |