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Gastrointestinal Surgical Patients' Outcomes Influenced by Nutrition

AORN Journal, Jan, 2000 by Karla Ernst Reiland

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Total enteral nutrition should be used in preference to TPN, except when less than 10 cm of bowel remain or multiple inoperable obstructions exist. Reducing serious complications with less cost and easier administration makes TEN a feasible first choice. Figure 1 shows acute care TPN and TEN cost comparisons of equipment, nursing time, laboratory studies, and amino acid solutions !n Pennsylvania Hospital, Philadelphia.

[Figure 1 ILLUSTRATION OMITTED]

SUMMARY

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Nutritional support is sometimes an overlooked aspect of care in the patient undergoing a gastrointestinal surgical procedure. Postoperative complications forced us to acknowledge the importance of feeding the patient and to implement patient feeding. Continuing reluctance to use TEN as a route of nutrition in the postoperative patient is not supported by our current knowledge. Distressing diarrhea after enteral intubation is a deterrent to its use and is often the reason TEN is discontinued or not used. More research should focus on the best methods to achieve optimal nutrition using TEN in gastrointestinal surgical patients. Nutrition needs are paramount preoperatively. Surgical team members might consider access during the procedure, allowing TEN to be an easier, more effective, and less costly management option. Perioperative RNs and advanced practice nurses can improve surgical outcomes by maximizing surgical patients' nutritional status.

NOTES

(1.) R Baigrie, P Devitt, S Watkin, "Enteral versus parenteral nutrition after esophagogastric surgery: A prospective randomized comparison," Australian and New Zealand Journal of Surgery 66 (October 1996) 668-670.

(2.) The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group, "Perioperative total parenteral nutrition in surgical patients," New England Journal of Medicine 325 (Aug 22, 1991) 525-532.

(3.) Ibid.

(4.) Ibid.

(5.) F A Moore et al, "Early enteral feeding, compared with parenteral, reduces postoperative septic complications: The results of a meta-analysis," Annals of Surgery 216 (August 1992) 172-183; K Kudsk et al, "Enteral versus parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma," Annals of Surgery 215 (May 1992) 503-513; F A Moore et al, "TEN versus TPN following major abdominal trauma--reduced septic morbidity" The Journal of Trauma 29 (July 1989) 916-923.

(6.) Kudsk et al, "Enteral vs parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma," 503-513.

(7.) Moore et al, "Early enteral feeding, compared with parenteral, reduces postoperative septic complications: The results of a meta-analysis," 172-183.

(8.) Kudsk et al, "Enteral vs parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma," 503-513.

(9.) Ibid.

(10.) J V Reynolds et al, "Does the route of feeding modify gut barrier function and clinical outcome in patients after major upper gastrointestinal surgery?" Journal of Parenteral and Enteral Nutrition 21 (July/August 1997) 196-201; R Beier-Holgersen, S Boesby, "Influence of postoperative enteral nutrition on postsurgical infections," Gut 39 (December 1996) 833-835; Baigrie, Devitt, Watkin, "Enteral versus parenteral nutrition after esophagogastric surgery: A prospective randomized comparison," 668-670; C Carr et al, "Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection," The British Medical Journal 312 (April 1996) 869-871; R Bower et al, "Postoperative enteral versus parenteral nutrition," The Archives of Surgery 121 (September 1986) 1040-1045.

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Gastrointestinal Surgical Patients' Outcomes Influenced by Nutrition

AORN Journal, Jan, 2000 by Karla Ernst Reiland

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