Status and nutritional therapy in elective and emergency neurosurgery patients

Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14^th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used.

Results:

80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%).

Conclusion:

The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

Descriptors:
Enteral Nutrition; Neurosurgery; Nutritional Evaluation; Malnutrition; Status

	Type of Surgery		p value
	Elective (n= 17)	Emergency (n= 63)	p value
Age
Mean ±SD	55.4 ±14.8	53.3 ±17.9	0.66
Gender
Male	9 (52.9%)	35 (55.6%)	0.84
Female	8 (47.1%)	28 (44.4%)	0.84
Comorbidities
Diabetes Mellitus	2 (11.8%)	10 (15.9%)	1.00
Hypertension	7 (41.2%)	38 (60.3%)	0.17
Chronic Kidney Disease	0 (0%)	1 (1.6%)	--
Surgical indication
Trauma	1 (5.9%)	27 (42.9%)	<0.01
Stroke	1 (5.9%)	15 (23.8%)	0.17
AMF/Aneurysm	4 (23.5%)	16 (25.4%)	1.00
Neoplasm	10 (58.8%)	2 (3.2%)	<0.01
Others	1 (5.9%)	3 (4.7%)	---
SOFA *
Median	10	9	0.65
Min - Max	0- 8	0 19	0.65
GCS *
Median	10	9	0.14
Min - Max	0-15	0-19	0.14

	Type of Surgery		p value
	Eletiva (n=17)	Urgência (n=63)	p value
Time of beginning of ENT (days) n=80
Median	1.0	1.0	0.97
Min - Max	0 - 3	0 - 3	0.97
Caloric adequacy (average percentage)
1^st- 3^rd day ENT (n=80)	63.9 ±23.5	71.5 ±25.9	0.20
4^th- 7^th day ENT (n=74)	84.3 ±15.3	86.7 ±23.7	0.40
Up to the 14^th day ENT (n=80)	76.5 ±16.4	79.4 ±22.0	0.29
Protein adequacy (average percentage)
1^st- 3^rd day ENT (n=80)	44.4 ±20.4	50.6 ±22.4	0.37
4^th- 7^th day ENT (n=74)	81.4 ±17.9	81.8 ±38.1	0.97
Up to the 14^th day ENT (n=80)	66.3 ±21.2	70.3 ±28.8	0.46

	Type of Surgery		p value
	Elective (n=17)	Emergency (n=63)	p value
Calorias Não Dietéticas (parenterais) (percentual médio)
1^st- 3^rd day ENT (n=62)	17.6 ±9.1	17.6 ±9.6	0.87
4^th- 7^th day ENT (n=45)	14.1 ±10.4	12.1 ±9.3	0.57
Up to the 7^th day ENT (n=64)	17.0 ±9.6	15.2 ±8.1	0.67
Proteína Isolada (percentual médio)
1^st- 3^rd day ENT (n=12)	26.0 ±6.1	25.6 ±7.9	0.95
4^th- 7^th day ENT (n=34)	24.2 ±12.3	28.6 ±11.5	0.40
Up to the 7^th day ENT (n=36)	31.1 ±16.8	24.9 ±8.0	0.34

	Type of Surgery		p value
	Elective	Emergency	p value
Day 2 (n= 78)
Reflux/GI Residue	7 (46.7%)	22 (34.9%)	0.95
Probe displacement	0 (0%)	3 (4.7%)
Need for Fasting	10 (66.7%)	23 (34.9%)	0.02
Day 3 (n= 76)
Reflux/GI Residue	6 (40.0%)	24 (39.3%)	0.96
Probe displacement	2 (13.3%)	1 (1.6%)	0.09
Need for Fasting	8 (53.3%)	25 (41.0%)	0.38
Day 4 (n= 73)
Reflux/GI Residue	7 (50.0)	24 (40.7%)	0.52
Probe displacement	2 (14.3%)	0 (0%)
Need for Fasting	6 (42.9%)	24 (40.7%)	0.88
Day 5 (n= 69)
Reflux/GI Residue	4 (30.8%)	27 (48.2%)	0.25
Probe displacement	1 (7.7%)	4 (7.1%)	1.00
Need for Fasting	2 (15.4%)	18 (32.1%)	0.23
Day 6 (n= 68)
Reflux/GI Residue	3 (25.0%)	21 (37.5%)	0.41
Probe displacement	0 (0%)	6 (10.7%)
Need for Fasting	2 (16.7%)	18 (32.1%)	0.28
Day 7 (n= 64)
Reflux/GI Residue	3 (27.3%)	20 (38.5%)	0.48
Probe displacement	2 (18.2%)	6 (11.3%)	0.53
Need for Fasting	4 (36.4%)	18 (34.0%)	0.87

	Inicial	7 dias	14 dias	p value
Elective	n=17	n=14	n=8
BMI (kg/m²)	27.1 (19.0; 38.2)	28.5 (17.0; 38.4)	28.3 (17.3; 38.7)	0.79
AC (cm)	32.0 (25.3; 39.0)	31.9 (23.7; 39.2)	30.6 (24.0; 39.5)	0.74
TSF (mm)	21.0 (8.0; 45.0)	19.8 (7.5; 43.2)	22.5 (11.5; 42.8)	0.67
Urgência	n=63	n=52	n=33
BMI (kg/m²)	26.6 (18.0; 41.8)	24.9 (13.2; 39.0)	25.0 (15.2; 39.5)	<0.01
AC (cm)	30.3 (24.0; 43.0)	29.5 (19.3; 42.0)	28.5 (21.4; 42.4)	<0.01
TSF (mm)	16.7 (1.7; 44.0)	15.6 (1.5; 39.0)	16.0 (1.8; 32.0)	0.14

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[1] Corresponding Author: Márcia Maria Teixeira de Freitas E-mail: mmtfreitas@hotmail.com