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Gastrointestinal Surgical Patients' Outcomes Influenced by Nutrition

AORN Journal, Jan, 2000 by Karla Ernst Reiland

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POSTOPERATIVE NUTRITION FOR PATIENTS ELECTING TO HAVE GASTROINTESTINAL SURGERY

Postoperative nutritional management of the patient who has undergone a gastrointestinal surgical procedure should be considered.(10) Published research relating to the care of this population seems somewhat weaker, older, and more anecdotal than the post-traumatic population analyses, when surgical techniques and nutritional management were probably practiced by memory and derived by tradition.(11)

One study found no clinical difference between TPN and TEN in postoperative complication rates.(12) Current literature attributes the improved outcome relating to morbidity and mortality to improved surgical technique.(13) Another study demonstrates that enteral nutrition is one surpassing factor in reducing postoperative complications.(14)

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Beginning postoperative enteral therapy. Small bowel function returns one to two hours after a surgical procedure, allowing fluid and nutrition to be administered. Researchers report bowel function is not adversely affected by a longer duration of surgery.(15) Bowel function can be evaluated by myoelectric activity. Physicians place electrodes on the seromuscular layer of the patient's gastrointestinal tract at the end of a surgical procedure to evaluate peristaltic activity. This confirms that audible bowel sounds do not correlate with the return of bowel function.(16) After surgery, gastric and colonic motility do not rebound as quickly as the small bowel. These organs need to remain decompressed and drained to optimize early function.

A patient's metabolic need increases when nutrition is electively withheld. An estimated 10% of lean muscle mass can be lost before wound healing and immunity are compromised. This loss can happen in five to seven days.(17) Time is critical if form and function are to be preserved.

Choosing enteral therapy. If gastrointestinal surgical procedures can be anticipated, then preoperative consideration of nutritional management, need, and alternatives help optimize results. Enteric intubation--a step often overlooked during preoperative planning--can be done intraoperatively. This therapy can be safely used for most patients who have gastric surgical procedures with an anticipated nutrition deprivation that may last more than five days. It is not always known which patients will need this support. The patients' prealbumin, albumin, and transferrin levels are the best indicators and provide opportunities to alleviate these specific nutritional needs.(18)

Postoperatively, nutrition management choices are limited if no planning has occurred. A jejunostomy tube insertion can be planned preoperatively to gain easy access to provide nutritional support during gastrointestinal surgical procedures. The increasing availability of TPN and its relatively easy administration make this a preferred route of nutrition, but the specter of complications and its high cost should make it the last choice.

Nutrition is sometimes a neglected care parameter in the surgical suite and the postoperative ward. Using energy the body diverts from the liver, muscles, and fat has subtle, but profound, effects on body homeostasis and influences healing and recovery time. The viscera is essential in supporting tissue growth. Its vital absorptive process maintains protein metabolism. Nutrition must be stressed during the preoperative evaluation. Ignoring or neglecting nutritional management and the patient's ongoing evaluation predisposes the bowel to atrophy and malfunction, including the translocation of bowel bacteria that might exponentially increase the rate of postoperative complications.(19)

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Gastrointestinal Surgical Patients' Outcomes Influenced by Nutrition

AORN Journal, Jan, 2000 by Karla Ernst Reiland

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