Perioperative Nutrition Intervention Enhanced Recovery after Gastrointestinal Surgery: a Prospective Single-center Cohort Study

  Objective  The aim of this study was to evaluate the safety and efficacy of enhanced recovery after surgery (ERAS) program focusing on the concept of integrative clinical nutrition for the gastrointestinal surgery.

  Methods  This study was a prospective single-center cohort study. Patients who underwent gastrointestinal surgery in the Department of General Surgery of Peking Union Medical College Hospital from December 2015 to April 2018 were continuously enrolled in the study. Patients who were treated by the professional team of gastrointestinal and nutritional metabolism and received ERAS management were assigned to the ERAS group, and patients who were treated by the other professional teams and received traditional perioperative management were assigned to the control group. The ERAS program included especially focusing on the preoperative nutritional assessment, nutritional supplements by oral or tube feeding, early postoperative enteral nutrition, combination with other series of ERAS items including minimally invasive surgery, multimodal analgesia, non-steroidal antiinflammatory drugs as major postoperative analgesic meditation, and so on. The control group was under traditional perioperative management including open or minimally invasive surgery, general anesthesia, opioid analgesia, and so on. The primary outcome was the postoperative length of stay, the secondary outcomes included total hospitalization cost, the incidence of postoperative complications, and readmission rate within postoperative 60 days.

  Results  Two hundred and four patients undergoing gastrointestinal surgery were enrolled, 102 patients in the ERAS group and the other 102 in the control group. The postoperative length of stay in the ERAS group was significantly shorter than that in the control group(7.2±4.5)days vs. (9.8±4.8)days, P < 0.001 and total hospitalization cost in the ERAS group was significantly lower than that in the control group(41 125±18 593)Yuan vs. (51 512±19 453)Yuan, P < 0.001 as well. There was no significant difference in the incidence of postoperative complications (Clavien-Dindo classification ≥ grade Ⅱ, ERAS group 9.8% vs. control group 13.7%, P=0.646) and readmission rate within postoperative 60 days (ERAS group 2.9% vs. control group 2.0%, P=1.000) between the two groups.

  Conclusion  Perioperative nutrition-focused ERAS programs are safe and effective for the gastrointestinal surgery and might enhance the recovery after surgery.