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 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 (

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.

Informations de copyright

© The Author(s) 2020.

Déclaration de conflit d'intérêts

Competing interestsSS, BAC, and RH are employees and stockholders of Abbott. PEW has received grant funding related to this work from NIH, Canadian Institutes of Health Research, Abbott, Baxter, Fresenius, Nutricia, and Takeda. PEW serves as a consultant to Abbott, Fresenius, Baxter, Cardinal Health Nutricia, and Takeda for research related to this work; received unrestricted gift donation for surgical and critical care nutrition research from Musclesound and Cosmed; and received honoraria or travel expenses for CME lectures on improving nutrition care in surgery and critical care from Abbott, Baxter, and Nutricia. DGAW receives support from NIH T32 Anesthesiology Department Research Training Grant.