Nutritional status and evaluation of the perioperative fasting time among patients submitted to elective and emergency surgeries at a reference hospital.

Lucchesi, Fabiana de Arruda; Gadelha, Patrícia Calado Ferreira Pinheiro

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Revista do Colégio Brasileiro de Cirurgiões

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Original Article • Rev. Col. Bras. Cir. 46 (4) • Jul-Aug 2019 • https://doi.org/10.1590/0100-6991e-20192222 copy

Nutritional status and evaluation of the perioperative fasting time among patients submitted to elective and emergency surgeries at a reference hospital.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to evaluate the clinical, surgical, and nutritional profile of surgical patients admitted to a reference hospital in Recife city, Pernambuco state, Brazil.

Methods:

a cross-sectional study carried out in the wards of the General Surgery Service of Hospital da Restauração Governador Paulo Guerra, from June to September 2018. We included adult and elderly patients (both genders) who were submitted to thoracoabdominal procedures and elective or emergency abdominal surgeries, and in which the assessment of nutritional status could be performed within 72 hours of hospital admission. Data on nutritional status and surgical procedures, as well as clinical and biochemical information, were collected.

Results:

we studied 140 patients with median age of 45 years. Among all, 59.3% were female and 23% malnourished, according to Subjective Global Assessment. The median preoperative fasting time was 15 hours for size I surgeries and 13.5 hours for size II ones. Longer postoperative hospital stay showed a strong correlation with the total length of hospital stay in both surgical sizes. Malnourished patients had a longer period of perioperative fasting and hospital stay when compared to well-nourished patients (p<0.001).

Conclusion:

the perioperative fasting time for elective surgeries was longer than recommended by literature. Patients with longer fasting spent more time in hospital.

Keywords:
Nutrition Assessment; General Surgery; Nutritional Status; Fasting.

	n	%
Clinical diagnose (n=140)
Cholelithiasis	61	43.6
Choledocolithiasis	9	6.4
Hernias^* * Epigastric, abdominal, and inguinal hernias;	33	23.6
Megaesophagus/Achalasia	8	5.7
Chest trauma	7	5.0
Abdominal trauma^ gunshot wound (GSW), stab wound (SW), car accident;	11	7.9
GIT neoplasms^* ***** gastrointestinal tract; (superior)	2	1.4
GIT neoplasms^* ***** gastrointestinal tract; (inferior)	4	2.9
Other neoplastic diseases	3	2.1
Appendicitis	2	1.4
Comorbidities (n=140)
Diabetes mellitus	2	1.4
Systemic arterial hypertension	33	23.6
Diabetes mellitus + Systemic arterial hypertension	8	5.7
Endoscopic/Thoracic procedures (n=24)
Peroral endoscopic myotomy	8	33.3
Endoscopic retrograde cholangiopancreatography	9	37.5
Closed thoracic drainage	7	29.2
Diagnosis of abdominal surgical size (n=116)
Size I (n=107)
Cholecystectomies	61	57.0
Herniorraphies	32	29.9
Appendectomies	3	2.8
Others^** ****** non-therapeutic laparotomies (with or without organ sutures).	11	10.3
Size II (n=9)
Partial or total gastrectomy	3	33.3
Colorectal surgery	5	55.6
Ostomies	1	11.1
Surgical technique (n=140)
Exploratory laparotomy	56	40.0
Videolaparoscopy	60	42.9
Endoscopy	17	12.1
Thoracic drainage	7	5.0
Character of the surgery (n=140)
Elective	119	85.0
Emergency	21	15.0

	Time	Min-Max
Size I
Hospital stay (in days)	1.0 (1.0-2.0)^ Median- interquartile range (25th and 75th percentiles);	1.0-12.0
Preoperative fasting time^* * Except patients undergoing emergency surgeries; (n=96) (in hours)	15.0 (13.0-18.0)^ Median- interquartile range (25th and 75th percentiles);	8.0-23.0
Surgery duration (in hours)	1.2 (1.0-2.0)^ Median- interquartile range (25th and 75th percentiles);	0.3-4.0
Postoperative fasting time (in hours)	6.0 (4.0-15.0)^ Median- interquartile range (25th and 75th percentiles);	1.0-29.0
Postoperative hospital stay time (in days)	1.0 (1.0-2.0)^ Median- interquartile range (25th and 75th percentiles);	1.0-9.0
Size II
Hospital stay (in days)	11.2±6.0^* ***** Mean ± standard deviation.	4.0-22.0
Preoperative fasting time^* * Except patients undergoing emergency surgeries; (n=6) (in hours)	13.5 (12.0-16.0)^ Median- interquartile range (25th and 75th percentiles);	11.0-48.0
Surgery duration (in hours)	3.4±1.2^* ***** Mean ± standard deviation.	2.0-5.7
Postoperative fasting time (in hours)	21.0 (17.0-23.7)^ Median- interquartile range (25th and 75th percentiles);	11.0-50.0
Postoperative hospital stay time (in days)	7.4±4.8^* ***** Mean ± standard deviation.	4.0-18.0

	Length of hospitalization (in days)	p-value^ Spearman correlation test.
Size I (n=107)
Preoperative fasting time^* * Except patients undergoing emergency surgeries; (in hours) (n=96)	-0.312	0.002
Surgery duration (in hours) (n=107)	0.272	0.004
Postoperative fasting time (in hours) (n=107)	0.341	<0.001
Postoperative hospital stay time (in days) (n=107)	0.747	<0.001
Size II (n=9)
Preoperative fasting time^* * Except patients undergoing emergency surgeries; (in hours) (n=6)	0.087	0.803
Surgery duration (in hours) (n=9)	0.765	0.012
Postoperative fasting time (in hours) (n=9)	0.025	0.913
Postoperative hospital stay time (in days) (n=9)	0.752	0.015

	Nutritional status (n=140)
	Malnourished	Well-nourished	p-value^* * Mann-Whitney test.
Preoperative fasting time (in hours)	20.0 (14.0-23.0)	14.0 (13.0-18.0)	0.002
Surgery duration (in hours)	2.0 (1.0-2.25)	1.25 (1.0-2.0)	0.145
Postoperative fasting time (in hours)	15.0 (12.0-21.25)	6.0 (4.0-15.5)	<0.001
Hospital stay time (in days)	4.0 (3.0-5.0)	2.0 (1.0-2.5)	<0.001

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[1] Mailing address: Fabiana de Arruda Lucchesi E-mail: fabianalucchesi@hotmail.com