Nutritional deficiency amongst hospitalised patients is common, and is often unrecognised and untreated. Over the last decade there has been a ro le-out of a number of strategies to standardise and improve the quality of perioperative care in surgical patients. Many such strategies have been gathered together under the umbrella term ERAS or enhanced recovery after surgery. We examine the evidence for specific elements of many such programmes, focusing particularly upon the provision of nutrition. We review the evidence for parenteral, enteral and oral nutritional support in the perioperative and postoperative period. The body of this work comprises four main projects; three clinical experiments and one original literature review. With data suggesting early feeding is preferential to 'nil by mouth' in terms of morbidity and hospital length of stay we set out to determine the most important periods in which to provide nutritional support by assessing the temporal relationship between nutrition provision and surgery. In Experiment One, a prospective four-armed double-blind randomised control trial, patients were allocated to one of four nutritional interventions: control pre-op/control post-op, active pre-op/control post-op, active pre-op/active post-op and control preop/ active post-op. Patients were either given pre-op® or placebo preoperatively, or fortifresh® or placebo postoperatively according to allocation. The provision of parenteral nutrition (PN) to 'stressed' patients often results in hyperglycaemia, which may be detrimental. In animal models small amounts of enteral nutrition (EN) improve intestinal integrity and stimulate intestinal incretin production, which may lead to improved glucose control. In Experiment Two, a prospective randomized control trial, we set out to assess if combining EN with PN results in improved glucose homeostasis rather than PN given alone. In undertaking this far-reaching work it was clear that the focus of nutritional supplementation has to date centred upon hospital inpatients. As part of this thesis a systematic review was undertaken reviewing the evidence for nutritional support in the community setting post-discharge.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:658031 |
| Date | January 2013 |
| Creators | Lidder, Paul G. |
| Publisher | Exeter and Plymouth Peninsula Medical School |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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