Newsletter

[ Vol. 11 No. 1 ] (January - April 2010 )
Happy and fed patients recover better

Patrick Ball
CharlesSturt University, Wagga Wagga, Australia 

Surgery has the power to save or hugely improve patients’ lives. Since its earliest beginnings it has been understood to induce a metabolic response, and pain. In this age of evidence-based healthcare it is apparent that we are a) still lacking evidence in a number of areas and b) a long way from comprehensive implementation of the evidence we have. Management of pain and post-operative nausea and vomiting is still sub-optimal in many hospitals. Medications are frequently prescribed ‘when necessary’ when surgical pain is constant and regular dosing before the pain returns is better therapy. Prolonged starvation before a general anaesthetic, and waiting for bowel sounds and flatus before commencing post-operative feeding were based upon opinion not evidence. Today, the work of the Fast-Track Surgery group and the ERAS (Enhanced Recovery After Surgery) group have provided evidence encouraging much shorter pre-operative starvation, carbohydrate pre-treatment prior to surgery and much earlier re-introduction of both feeding and oral medication after surgery. Jens Kondrup, Simon Allison and others have shown that hospital meals do not serve the needs of sick patients, because of fixed meal times and limited menus; a range of attractive food available ‘on demand’ often in smaller portions, will encourage many surgical patients to eat more and sooner. Supplementary and interventional feeding is often considered by managers to be expensive and has the potential to increase costs and complications if done poorly, but the evidence is growing that when nutrition support is done well, recovery is quicker, complications are fewer and overall costs to healthcare providers are lower. The debate about optimal use of parenteral nutrition continues (Woodcock, Zeigler et al. 2001), and we are still learning how optimally to use nutraceuticals, but it is clear that effective pain management and good nutrition leads to better outcomes and earlier discharge.

REFERENCES / FURTHER READING

• Woodcock, N. P., D. Zeigler, et al (2001). “Enteral versus parenteral nutrition: a pragmatic study.[see comment].” Nutrition 17(1): 1-12.
• A useful list of references and abstracts can be found at: http://www.health.wa.gov.au/HRIT/clinicalplanning /docs/ERASfastTrackSurg.pdf

From   
PENSA 2009
“Energizing Nutrition Support Practice for Life”
June 5-7 2009, Shangri-La Hotel, Kuala Lumpur, Malaysia 
Page: 54