11/18/2023 0 Comments Reesa noi post opArginine is essential for the functioning of immune cells and operates as a precursor to proline and polyamines, which are necessary for tissue repair and wound healing.4 Fish oil-derived omega-3s mediate the inflammatory response.4 A synergy among the ingredients could play an important role.4 However, the two ingredients that appear to provide the most benefit are the conditionally essential amino acid arginine and omega-3s derived from fish oils. Because of the varying formulations (some product preparations differ from country to country from a single manufacturer), the ingredients most responsible for benefiting surgical outcome aren't easily identified.4 Among the ingredients found in these types of supplements are arginine, omega-3s, nucleotides, prebiotics, probiotics, vitamin E, and high-quality protein, and antioxidants often are included. IN supplements, such as Impact Advanced Recovery and Nutren Optimum, vary in ingredients and concentrations, and the ideal dosages for the best surgical outcome haven't been defined. But ERAS protocols incorporate several components in various combinations, many of them unrelated to nutrition, such as rapid mobilization following surgery, no nasogastric tube, early removal of catheters, and the use of warm IV fluids, making it difficult to specifically identify nutritional support as the deciding factor in a patient's ease of recovery. ![]() In addition to a shorter length of hospital stay, some of the benefits of ERAS may be earlier return of bowel function, decreased time to mobilization for patients, fewer postoperative complications, ability to tolerate solid foods sooner, and lower readmission within 30 days postsurgery. Poor palatability, leading to poor patient compliance, defeats the purpose of any nutrition prescription.4 Moreover, a recent literature review found no statistical difference in infections, complications, and length of hospital stay between patients given IN or ONS.4įindings from studies on ERAS protocols contradict traditional management of postsurgical patients, which typically calls for prolonged fasting before surgery and a clear liquid postsurgery diet. Available in a wide variety of flavors, ONS products, such as Ensure, Boost, and Resource 2.0, typically are much less expensive and far more palatable than IN, resulting in better patient compliance. ONS, most often in liquid form, provide extra protein and calories to supplement a patient's diet. ![]() Two main approaches to pre- and postoperative nutrition have been studied the most: standard oral nutrition supplements (ONS) and immunonutrition (IN) supplements. If you're not well trained, if you're not ready for surgery, you're not going to do well." "Surgery is like a sport," Evans said, "and we have to be the trainers. Surgery poses a catabolic stress on the body, which triggers inflammation and depletes nutrients this, in turn, can impair the immune response and increase the risk of postoperative complications, especially infections.4 The third congress of the society is slated to meet in May 2015 in Washington, D.C., to discuss these protocols and determine if they need to be updated. Formed in Sweden, the ERAS Society has developed protocols, which include such nutrition guidelines. So why aren't nutrition assessments and pre- and postsurgical nutrition interventions routine in many hospitals?ĭavid Evans, MD, of The Ohio State University, an outspoken advocate for nutrition assessment and support both pre- and postsurgery, offered some insight at the Academy of Nutrition and Dietetics' Food & Nutrition Conference & Expo in October 2014, when he said, "Traditional beliefs still persist among surgeons to delay initiating nutrition support, despite recommendations to the contrary." The recommendations he's referring to, known as "enhanced recovery of patient after surgery," or ERAS, urge preoperative nutrition assessments and counseling prebiotic/probiotics administration limiting preoperative fasting to two to three hours, rather than the traditional six to 12 hours and immediate postoperative fluid and diet initiation, to name a few approaches. It's a little-appreciated fact that up to 50% of patients are malnourished when they're admitted to the hospital, yet according to a Johns Hopkins study, only about 20% of patients receive a nutritional consult.1 Another surprising fact: Malnutrition increases the risk of death after surgery, significantly raises the risk of postoperative complications, and is a chief reason why patients are readmitted to the hospital.2 In addition, hospital stays are longer and health care costs can be more than 60% greater for malnourished patients.3 It affects all ages, but the elderly are especially vulnerable. ![]() RDs can ensure patients are well nourished before procedures to ease recovery, shorten hospital stays, and reduce complications.
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