Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations Guidelines for Perioperative Care in Elective Rectal/Pelvic Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study Reduced postoperative infections with an immune-enhancing nutritional supplement. Nutritional approach in malnourished surgical patients: a prospective randomized study. Substitution of Usual Perioperative Care by eHealth to Enhance Postoperative Recovery in Patients Undergoing General Surgical or Gynecological Procedures: Study Protocol of a Randomized Controlled Trial A New Parameter for Assessing Postoperative Recovery of Physical Activity Using an Accelerometer Efficacy of therapeutic suggestions for improved postoperative recovery presented during general anesthesia. Postoperative enteral vs parenteral nutrition. A randomized controlled trial. Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery. A simplified rehabilitation program for patients undergoing elective colonic surgery—randomized controlled clinical trial Effects of Preoperative Enteral Nutrition on Postoperative Recent Nutritional Status in Patients with Siewert II and III Adenocarcinoma of Esophagogastric Junction after Neoadjuvant Chemoradiotherapy Perioperative goal-directed therapy and postoperative outcomes in patients undergoing high-risk abdominal surgery: a historical-prospective, comparative effectiveness study Nutritional and anthropometric assessment of the scope for dietary optimization during staging prior to pancreaticoduodenectomy.
Background This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide grade d recommendations for items for an evidence d-based enhanced perioperative protocol . Methods Studies were selected with particular attention paid to meta-analyses , r and omised controlled trials and large prospect i ve cohorts . For each item of the perioperative treatment pathway , available English- language literature was examined , review ed and grade d. A consensus recommendation was reached after critical appraisal of the literature by the group . Results For most of the protocol items , recommendations are based on good- quality trials or meta-analyses of good- quality trials ( quality of evidence and recommendations according to the GRADE system ) . Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway , the Enhanced Recovery After Surgery ( ERAS ) Society , International Association for Surgical Metabolism and Nutrition ( IASMEN ) and European Society for Clinical Nutrition and Metabolism ( ESPEN ) present a comprehensive evidence -based consensus review of perioperative care for colonic surgery Background This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery , and to provide grade d recommendations for items for an evidence d-based enhanced recovery protocol . Methods Studies were selected with particular attention paid to meta-analyses , r and omized controlled trials and large prospect i ve cohorts . For each item of the perioperative treatment pathway , available English- language literature was examined , review ed and grade d. A consensus recommendation was reached after critical appraisal of the literature by the group . Results For most of the protocol items , recommendations are based on good- quality trials or meta-analyses of good- quality trials ( evidence grade : high or moderate ) . Conclusions Based on the evidence available for each item of the multimodal perioperative care pathway , the Enhanced Recovery After Surgery ( ERAS ) Society , European Society for Clinical Nutrition and Metabolism ( ESPEN ) and International Association for Surgical Metabolism and Nutrition ( IASMEN ) present a comprehensive evidence -based consensus review of perioperative care for rectal surgery BACKGROUND & AIMS Protocol s for enhanced recovery provide comprehensive and evidence -based guidelines for best perioperative care . Protocol implementation may reduce complication rates and enhance functional recovery and , as a result of this , also reduce length-of-stay in hospital . There is no comprehensive framework available for pancreaticoduodenectomy . METHODS An international working group constructed within the Enhanced Recovery After Surgery ( ERAS ® ) Society constructed a comprehensive and evidence -based framework for best perioperative care for pancreaticoduodenectomy patients . Data were retrieved from st and ard data bases and personal archives . Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group . The quality of evidence was rated " high " , " moderate " , " low " or " very low " . Recommendations were grade d as " strong " or " weak " . RESULTS Comprehensive guidelines are presented . Available evidence is summarised and recommendations given for 27 care items . The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations . CONCLUSIONS The present evidence -based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy . A unified protocol allows for comparison between centres and across national borders . It facilitates multi-institutional prospect i ve cohort registries and adequately powered r and omised trials Background Protocol s for enhanced recovery provide comprehensive and evidence -based guidelines for best perioperative care . Protocol implementation may reduce complication rates and enhance functional recovery and , as a result of this , also reduce length-of-stay in hospital . There is no comprehensive framework available for pancreaticoduodenectomy . Methods An international working group constructed within the Enhanced Recovery After Surgery ( ERAS ® ) Society constructed a comprehensive and evidence -based framework for best perioperative care for pancreaticoduodenectomy patients . Data were retrieved from st and ard data bases and personal archives . Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group . The quality of evidence was rated “ high ” , “ moderate ” , “ low ” or “ very low ” . Recommendations were grade d as “ strong ” or “ weak ” . Results Comprehensive guidelines are presented . Available evidence is summarised and recommendations given for 27 care items . The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations . Conclusions The present evidence -based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy . A unified protocol allows for comparison between centres and across national borders . It facilitates multi-institutional prospect i ve cohort registries and adequately powered r and omised trials BACKGROUND AND AIMS The Enhanced Recovery after Surgery ( ERAS ) program has been proposed as a postoperative recovery-enhancing strategy . We frequently apply the Modified-ERAS program following oesophagectomy . This study aims to eluci date the impact of goal -directed fluid therapy ( GDT ) for the perioperative management of oesophageal cancer on the postoperative recovery of patients undergoing oesophagectomy . METHODS This is an interventional before-after comparative observational study conducted at Kanagawa Cancer Centre , Japan . Patients who underwent elective oesophagectomy for oesophageal cancer were recruited . Group H ( retrospectively collected ) received intraoperative and postoperative management consisting of fluid administration without haemodynamic monitoring and the M-ERAS program , while Group S prospect ively received management consisting of GDT and the M-ERAS program . The primary endpoint was the speed of gastrointestinal functional recovery , while secondary endpoints were the level of postoperative mobilisation , incidence of complications , postoperative length of hospital stay ( LOS ) , and nutritional status after discharge . RESULTS The proportion of patients who completely egested Gastrografin by postoperative day 4 , the level of postoperative mobilisation , and achievement ratio for a 100-m walk on the first postoperative attempt were significantly higher in Group S than in Group H ( P = 0.034 , P = 0.0197 , and P < 0.0001 , respectively ) . No significant differences were observed in the postoperative LOS and incidence of complications within 30 days between the groups . The serum albumin levels at 6 months after discharge was higher in Group S than in Group H ( P = 0.0002 ) . CONCLUSIONS The GDT-ERAS program enhanced postoperative gastrointestinal recovery and mobilisation , as well as postoperative nutritional status and protein synthesis . The program did not affect either postoperative LOS or the incidence of complications . TRIAL REGISTRATION UMIN registration number : UMIN000013705 , https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000015999 Background Multimodal protocol s of perioperative care may enhance postoperative recovery . However , limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty . We aim ed to investigate the effect of a multimodal protocol ( ACERTO protocol ) plus preoperative immune nutrition on the length of stay ( LOS ) and the postoperative acute phase response of patients undergoing total hip arthroplasty . Methods Thirty-two patients ( mean age , 58 years ; range , 26–85 years ; 16 males ) were r and omized to receive either the  ACERTO protocol  ( n = 15 , ACERTO Group ) , which consisted of 6 h preoperative fasting for solids , an oral drink ( 200 mL of 12.5 % maltodextrin ) up to 2 h before induction of anesthesia , restricted intravenous fluids ( only 1000 mL of crystalloid fluid after surgery ) and preoperative immune nutrition ( 600 mL/day of Impact - Nestlé , Brazil ) for five days prior to surgery , or traditional care ( n = 17 ; control group ) , which consisted of 6–8 h preoperative fasting , intravenous hydration until the 1st postoperative day and no preoperative immune supplementation . The main endpoint was LOS . C-reactive protein ( CRP ) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2 . Results Neither deaths nor postoperative complications occurred . The median LOS was 3 ( 2–5 ) days in the ACERTO group and 6 ( 3–8 ) days in controls ( P < 0.01 ) . Postoperative CRP was higher in the control group ( P < 0.01 ) . Conclusion The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty . Trial registration Clinical Trials : OBJECTIVES /HYPOTHESIS Malnutrition is a significant risk factor for postoperative infections in patients undergoing oncologic surgery . This study was undertaken to determine if perioperative nutritional supplementation with an immune-enhancing formula is superior to st and ard formula in the prevention of postoperative infectious complications . STUDY DESIGN This was a prospect i ve , r and omized , double-blind trial comparing perioperative nutritional supplementation with Impact and st and ard nutritional formulas . METHODS Following stratification , 136 patients undergoing oncologic head and neck surgery were r and omly assigned to one of four treatment groups : preoperative/postoperative Impact , postoperative Impact , preoperative/postoperative st and ard formula , and postoperative st and ard formula . Outcome measures included laboratory evaluations of nutritional status , infectious and wound healing complications , and duration of hospitalization . Statistical analysis was performed using chi2 or two-tailed Fisher Exact Tests , when appropriate . RESULTS Intent-to-treat ( P = .02 ) and actual therapy ( P = .04 ) analyses revealed a significant decrease in the incidence of postoperative infectious complications ( all sites ) in patients who received Impact . There was no significant difference in wound healing problems or duration of hospitalization . Postoperative measures of nutrition status demonstrated a higher serum albumin ( P = .05 ) in patients who received Impact compared with st and ard formula . CONCLUSIONS Compared with st and ard formula , perioperative nutritional supplementation with Impact significantly reduced the incidence of infectious complications . The length of hospitalization was significantly prolonged in patients with postoperative infections , suggesting potential cost savings with the use of immune-enhancing formulas such as Impact HYPOTHESIS Perioperative administration of a supplemented enteral formula may decrease postoperative morbidity . DESIGN R and omized clinical trial . SETTING Department of surgery at a university hospital . PATIENTS One hundred ninety-six registered malnourished patients ( weight loss > or = 10 % ) who were c and i date s for major elective surgery for malignancy of the gastrointestinal tract . INTERVENTION After r and omization ( n = 150 ) , one group received postoperative enteral feeding with a st and ard diet within 12 hours of surgery ( control group ; n = 50 ) . Another group orally received 1 L/d for 7 consecutive days of a liquid diet enriched with arginine , omega-3 fatty acids , and RNA ( preoperative group ; n = 50 ) . After surgery , patients were given the same st and ard enteral formula as the control group . A third group orally received 1 L/d for 7 consecutive days of the enriched liquid diet . After surgery , patients were given enteral feeding with the same enriched formula ( perioperative group ; n = 50 ) . MAIN OUTCOME MEASURES Postoperative complications and length of hospital stay . RESULTS The 3 groups were comparable for baseline demographics , biochemical markers , comorbidity factors , and surgical variables . The intent-to-treat analysis showed that the total number of patients with complications was 24 in the control group , 14 in the preoperative group , and 9 in the perioperative group ( P = .02 , control group vs perioperative group ) . Postoperative length of stay was significantly shorter in the preoperative ( 13.2 days ) and perioperative ( 12.0 days ) groups than in the control group ( 15.3 days ) ( P = .01 and P = .001 , respectively , vs the control group ) . CONCLUSION Perioperative immunonutrition seems to be the best approach to support malnourished patients with cancer Background Due to the strong reduction in the length of hospital stays in the last decade , the period of in-hospital postoperative care is limited . After discharge from the hospital , guidance and monitoring on recovery and resumption of ( work ) activities are usually not provided . As a consequence , return to normal activities and work after surgery is hampered , leading to a lower quality of life and higher costs due to productivity loss and increased health care consumption . Objective With this study we aim to evaluate whether an eHealth care program can improve perioperative health care in patients undergoing commonly applied abdominal surgical procedures , leading to accelerated recovery and to a reduction in costs in comparison to usual care . Methods This is a multicenter r and omized , single-blinded , controlled trial . At least 308 patients between 18 and 75 years old who are on the waiting list for a laparoscopic cholecystectomy , inguinal hernia surgery , or laparoscopic adnexal surgery for a benign indication will be included . Patients will be r and omized to an intervention or control group . The intervention group will have access to an innovative , perioperative eHealth care program . This intervention program consists of a website , mobile phone app , and activity tracker . It aims to improve patient self-management and empowerment by providing guidance to patients in the weeks before and after surgery . The control group will receive usual care and will have access to a nonintervention ( st and ard ) website consisting of the digital information brochure about the surgical procedure being performed . Patients are asked to complete question naires at 5 moments during the first 6 months after surgery . The primary outcome measure is time to return to normal activities based on a patient-specific set of 8 activities selected from the Patient-Reported Outcomes Measurement Information System ( PROMIS ) physical functioning item bank version 1.2 . Secondary outcomes include social participation , self-rated health , duration of return to work , physical activity , length of recovery , pain intensity , and patient satisfaction . In addition , an economic evaluation alongside this r and omized controlled trial will be performed from the societal and health care perspective . All statistical analyses will be conducted according to the intention-to-treat principle . Results The enrollment of patients started in September 2015 . The follow-up period will be completed in February 2017 . Data cleaning and analyses have not begun as of the time this article was su bmi tted . Conclusions We hypothesize that patients receiving the intervention program will resume their normal activities sooner than patients in the control group and costs will be lower . Clinical Trial Netherl and s Trial Registry NTC4699 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=4699 ( Archived by WebCite at http://www.webcitation.org/6mcCBZmwy Abstract Purpose . While many retrospective and prospect i ve observational studies have shown laparoscopic surgery to be less invasive than conventional open surgery , this issue has not been evaluated by objective parameters . Currently available clinical parameters , such as the day of first ambulation , the day food intake is commenced , and the length of postoperative hospital stay , are subjective . The purpose of this study was to investigate whether measuring postoperative physical activity with an accelerometer is a useful parameter for evaluating postoperative recovery after surgical stress . Methods . The subjects included 20 patients who underwent laparoscopic partial gastrectomy ( LPG group ) , 35 patients who underwent open distal gastrectomy ( ODG group ) , and 20 patients who underwent open total gastrectomy ( OTG group ) . The cumulative acceleration of voluntary movement , measured by an Active tracer AC-301 ( ACT ) accelerometer for 7 days postoperatively , was compared among these three groups . Results . The cumulative acceleration of physical activity for 24 h was significantly better in the LPG group than in the ODG and OTG groups on each postoperative day . The recovery time , defined as the day that cumulative acceleration had recovered to more than 90 % of the preoperative level , was significantly shorter in the LPG group ( 2.8 ± 0.9 days ) than in the ODG ( 6.6 ± 2.1 days ) and OTG ( 7.8 ± 1.2 days ) groups . Conclusion . These results showed that convalescence differed with the degree of surgical stress , and that measurement of the cumulative acceleration of voluntary movement by using an accelerometer could be a useful objective and quantitative parameter for evaluating postoperative recovery There have been cl aims that the postoperative course of patients may be improved by presentation during general anesthesia of therapeutic suggestions which predict a rapid and comfortable postoperative recovery . This study evaluated the effectiveness of such therapeutic suggestions under double-blind and r and omized conditions . A tape recording predicting a smooth recovery during a short postoperative stay without pain , nausea , or vomiting was played during anesthesia to about half the patients ( N = 109 ) , while the remaining , control patients were played a blank tape instead ( N = 100 ) . The patients were primarily undergoing operations on the fallopian tubes , total abdominal hysterectomy , vertical b and ing gastroplasty , cholecystectomy , and ovarian cystectomy or myomectomy . The anesthesia methods consisted of either isoflurane with 70 % nitrous oxide in oxygen to produce end-tidal concentrations of 1.0 , 1.3 , or 1.5 MAC ; or 70 % nitrous oxide in oxygen combined with high or low doses of opioids . Assessment s of the efficacy of the therapeutic suggestions in the recovery room and throughout the postoperative hospital stay included : the frequency of administration of analgesic and antiemetic drugs ; opioid doses ; the incidence of fever ; nausea , retching , and vomiting ; other gastrointestinal and urinary symptoms ; ratings of pain ; ratings of anxiety ; global ratings of the patients ' physical and psychological recoveries by the patients and their nurses ; and length of postoperative hospital stay . There were no meaningful , significant differences in postoperative recovery of patients receiving therapeutic suggestions and controls . These negative results were not likely to be due to insensitivity of the assessment s of recovery , as they showed meaningful interrelations among themselves and numerous differences in recovery following different types of surgery . Widespread utilization of therapeutic suggestions as a routine operating room procedure seems premature in the absence of adequate replication of previously published positive studies Twenty patients undergoing major upper-gastrointestinal-tract or pancreaticobiliary surgery were r and omized to receive postoperative nutritional support by total parenteral nutrition ( TPN ) or elemental diet administered by needle-catheter jejunostomy ( NCJ ) . Both routes of administration provided adequate nutritional support . No unexpected complications were encountered . The NCJ group compared favorably with the TPN group at the end of the seven-day trial . The NCJ group provided significant cost efficiency while maintaining adequate nutritional support BACKGROUND The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing gastrectomy procedures . METHODS According to r and omized controlled studies and conclusions made by meta-analyses in colorectal surgery , optimized perioperative measures were design ed and applied in gastrectomy surgery . Thirty-three patients were r and omized to the optimized group and 30 patients to a control group .  Two groups were treated in 1 center by a single surgical team in different wards . Both groups used patient-controlled intravenous analgesia for postoperative analgesia . The primary end point was length of postoperative hospital stay . Secondary outcomes included bowel function recovery after surgery , perioperative changes of inflammatory factors , glucocorticoid , insulin resistance , and body composition . Perioperative complications and adverse events were also recorded . RESULTS The groups were similar in terms of age , sex ratio , and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( POSSUM score ) . The optimized group was associated with a significantly shorter postoperative hospital stay compared with the conventional care group ( P < .001 ) . Duration s of urinary catheterization and abdominal drainage were also less ( P < .001 ) . The diet program in the optimization group was well tolerated and was associated with an earlier recovery of gut function ( P < .001 ) . Proinflammatory factors were less elevated and body composition was more stable in the optimized group than in controls . There were no differences in morbidity or mortality between the groups . CONCLUSIONS Optimization of care in gastrectomy can shorten postoperative hospital stay and provides multiple beneficial outcomes , including hastening the return of gut function , without increasing morbidity Background We have proposed a simplified perioperative rehabilitation program for elective colonic surgery that is focused on early oral nutrition and that could reduce hospital stay and postoperative ileus time without raising complications and readmission rates . Patients and methods Fifty-four patients admitted for elective colonic surgery were prospect ively r and omized into two groups : ( 1 ) an early feeding group (EFG)—on the first postoperative day , patients initially received a oral liquid diet and were advanced to a regular diet within the next 24 h as tolerated and at their discretion ; ( 2 ) a traditional care group— patients were managed by nothing per orus until the elimination of the first flatus and then su bmi tted to an oral liquid diet , followed by a regular diet within the next 24 h as described for the EFG . All patients followed a well-defined , simplified rehabilitation program . Results Patients ' baseline characteristics were similar in the two groups . Hospital stay was significantly lower in the EFG ( 4.0 [ ±3.7 ] versus 7.6 [ ±8.1 ] days ; p = 0.000 ) . Diet tolerance and progression were similar between groups . Time to first flatus after surgery was significantly lower in the EFG ( 1.5 [ ±0.5 ] versus 2.0 [ ±0.7 ] days ; p = 0.019 ) . Complication and readmission rates were similar in both groups . Conclusions Early oral nutrition associated with a simplified perioperative rehabilitation program reduces postoperative length of hospital stay and ileus time after elective colonic resection without increasing rates of complications or readmissions Abstract Objective : To study the effects of preoperative enteral nutrition ( EN ) on postoperative recent nutritional status ( PRNS ) in patients with Siewert II and III adenocarcinomas of esophagogastric junction ( AEG ) after neoadjuvant chemoradiotherapy ( NCRT ) . Methods : A total of 66 patients with resectable AEG ( Siewert II and III ) were r and omly divided into two groups . The trial group accepted oral nutrition supplementation ( ONS ) for 7 days before surgery while the control not . Results : Nutrition indexes were higher in trial group after surgery whereas the opposite was true for the diamine oxidase ( DAO ) and d-lactate ( P < 0.05 ) . The rate of malnutrition and nutritional risk became lower in trial group on the 8th day after surgery ( P < 0.05 ) . Injury levels of intestinal mucosa were more severe among control group . The recent prognosis was better in trial group . For patients with or without nutritional risks at admission , the PRNS and recent prognosis were improved by preoperative EN . Logistic regression analysis suggested that preoperative EN could be an independent protective factor of PRNS . Conclusions : Preoperative EN may improve the PRNS and recent prognosis of patients with Siewert II and III AEG after NCRT Introduction Perioperative goal -directed therapy ( PGDT ) may improve postoperative outcome in high-risk surgery patients but its adoption has been slow . In 2012 , we initiated a performance improvement ( PI ) project focusing on the implementation of PGDT during high-risk abdominal surgeries . The objective of the present study was to evaluate the effectiveness of this intervention . Methods This is a historical prospect i ve quality improvement study . The goal of this initiative was to st and ardize the way fluid management and hemodynamic optimization are conducted during high-risk abdominal surgery in the Departments of Anesthesiology and Surgery at the University of California Irvine . For fluid management , the protocol consisted in st and ardized baseline crystalloid administration of 3 ml/kg/hour and any additional boluses based on PGDT . The impact of the intervention was assessed on the length of stay in the hospital ( LOS ) and post-operative complications ( NSQIP data base ) . Results In the 1 year pre- and post-implementation periods , 128 and 202 patients were included . The average volume of fluid administered during the case was 9.9 ( 7.1–13.0 ) ml/kg/hour in the pre-implementation period and 6.6 ( 4.7–9.5 ) ml/kg/hour in the post-implementation period ( p < 0.01 ) . LOS decreased from 10 ( 6–16 ) days to 7 ( 5–11 ) days ( p = 0.0001 ) . Based on the multiple linear regression analysis , the estimated coefficient for intervention was 0.203 ( SE = 0.054 , p = 0.0002 ) indicating that , with the other conditions being held the same , introducing intervention reduced LOS by 18 % ( 95 % confidence interval 9–27 % ) . The incidence of NSQIP complications decreased from 39 % to 25 % ( p = 0.04 ) . Conclusion These results suggest that the implementation of a PI program focusing on the implementation of PGDT can transform fluid administration patterns and improve postoperative outcome in patients undergoing high-risk abdominal surgeries . Trial registration Clinical trials.gov NCT02057653 . Registered 17 December 2013 CONTEXT Although several studies have examined peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy all provided support at various timepoints with a variety of protocol s. OBJECTIVE This study undertakes a detailed nutritional and anthropometric assessment of patients due to undergo pancreaticoduodenectomy with particular reference to pre-operative nutritional status and peri-operative outcome . PATIENTS Twenty-six patients undergoing pancreaticoduodenectomy .  SETTING A regional hepatobiliary service . MAIN OUTCOME MEASURES Nutritional , anthropometric and clinical course details . DESIGN Data were collected prospect ively . RESULTS There was no significant change in any anthropometric index from baseline to immediately prior to surgery . However , there was a significant fall in BMI comparing baseline measurements to observations at time of discharge from hospital ( P<0.001 ) . There was , in addition , a significant difference between baseline and BMI at 3 months ( P<0.001 ) . Similar trends were observed in mid-arm circumference , triceps skin fold thickness and h and -grip . There was no in-hospital or 3-month post-operative mortality in this series . CONCLUSION Nutritional and anthropometric indices remain stable from the time of index admission to operation . However , there is a drastic and sustained reduction in nutritional indices in the post-operative period with this deficiency being sustained at 3-months after operation
this guideline reflects the recommendations of the group of specialists of the Brazilian College of Surgeons , the Brazilian Society of Parenteral and Enteral Nutrition and the ACERTO Project for nutritional interventions in the perioperative period of Elective General Surgery .
The prescription of these recommendations can accelerate the postoperative recovery of patients su bmi tted to elective general surgery , with decrease in morbidity , length of stay and rehospitalization , and consequently , of costs
OBJECTIVE to present recommendations based on the ACERTO Project ( Acceleration of Total Post-Operative Recovery ) and supported by evidence related to perioperative nutritional care in General Surgery elective procedures .