Are nutritional targets in the ERAS® bowel module achievable? – Evaluation of postoperative calorie and protein intake in elective bowel surgery during a pilot-RCT
Author(s): Julian Müller, Rico Wiesenberger, Mario Kaufmann, Christel Weiß, David Ghezel-Ahmadi, Julia Hardt, Christoph Reißfelder, Florian Herrle
Background & Aims: Patient recovery may be delayed if postoperative calorie requirements and daily nutritional targets recommended by the ERAS® protocol are not achieved. The ability and willingness of patients to fulfil those targets and the evidence-base are not clarified. This study evaluates calorie and protein requirements and intake within the setting of a pilot-RCT to discuss realistic guideline values for patients.
Methods: 60 patients (≥ 18 years) were included, following the certified surgical ERAS® bowel protocol. Patients used a study smartphone to record food intake. The amount of protein shakes drunk was recorded by the study personnel. Validated body sensors were used to record calorie consumption. Key endpoints were the number of protein-shakes drunk, proteins ingested and overall calorie intake.
Results: A total of 60 patients (34 men; mean age, 60.7 years) on median, drank a total of 4 protein-shakes for postoperative days 0-3 and a median of 1 shake per day. 43 patients had a higher calorie consumption (average 5642.4 kcal days 1-3) compared to their calorie intake (average 4452.8 kcal days 1-3). The ERAS® goal of drinking the specified number of sip-feeds on all postoperative days was achieved by only 9 of 59 patients (15.25%).
Conclusions: The ERAS®-targets for postoperative nutrition seems more arbitrary than evidence-based. They aim rather at detecting obstacles of delayed food intake and at establishing further approaches to counteract the postoperative protein and calorie deficit. We propose to identify more patient-centered, goal-oriented approaches like motivational interviewing to support patients towards their recovery goals.
Abbreviations: ASA, American Society of Anesthesiologists; BMI, body mass index; CCM, Cardiac contractility modulation; CRT, Cardiac resynchronization therapy; ERAS®, Enhanced Recovery after Surgery; ICD, Implantable cardioverter-defibrillator; IBD, inflammatory bowel disease; MI, Motivational Interviewing; PEG, percutaneous endoscopic gastrostomy; PG-SGA SF, Patient-Generated Subjective Global Assessment short form; RCT, randomized controlled trial; SAS, Statistical Analysis Software
Trial Registration: DRKS – Deutsches Register Klinischer Studien; DRKSID: DRKS00027863; https://drks.de/search/de/trial/DRKS00027863