Is there any Benefit of Short-Course Oral Nutrition Supplement on Surgical Outcomes in Mildly to Moderately Malnourished Patients Undergoing Colorectal Surgery Within an Enhanced Recovery after Surgery Protocol?
Varut Lohsiriwat MD, PhD*
Affiliation : * Colorectal Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : This study aimed to determine whether there is any clinical benefit of short-course oral nutrition supplement (ONS)
on surgical outcomes in mildly to moderately malnourished patients undergoing colorectal surgery within an enhanced
recovery after surgery (ERAS) protocol.
Material and Method: Patients with mild to moderate malnutrition (defined as those with subjective global assessment grade
B) undergoing elective colorectal resection within an ERAS protocol from 2011 to 2015 were reviewed. Patients receiving
perioperative ONS >600 calories per day (ONS group) were matched and compared with those with no supplement. Outcome
measures included postoperative complication, gastrointestinal recovery and length of postoperative stay.
Results : There were 29 patients in each group. Patient’s characteristics and operative details were comparable between the
two groups. Median calories and protein intake from ONS were 800 kcal and 32 gram per day. Median time of ONS provided
was 5 days. Patients receiving ONS had a non-significant shorter median time to resumption of solid diet (1 (IQR 1 to 3) vs.
2 (IQR 1 to 4) days; p = 0.27) and time to first defecation (2 (IQR 2 to 3) vs. 3 (IQR 2 to 4) days; p = 0.52). There was no
significant difference in the rate of overall, minor and major postoperative complication between the two groups: 28% vs.
24% (p = 0.76), 21% vs. 7% (p = 0.25) and 7% vs. 17% (p = 0.42), respectively. Median length of postoperative stay was
not different (5 (IQR 4 to 5) vs. 5 (IQR 4 to 7) days; p = 0.20).
Conclusion : Perioperative administration of ONS to non-severely malnourished patient fails to demonstrate any clinical
benefits on surgical convalescence after colorectal surgery.
Keywords : Oral nutrition supplement, Enhanced recovery after surgery, Colon, Rectum, Surgery
