Health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer: Results from the multi‐centre NOURISH point prevalence study. Issue 2 (11th April 2022)

• Record Type: Journal Article
• Authors: Deftereos, Irene; Yeung, Justin M. C.; Arslan, Janan; Carter, Vanessa M.; Isenring, Elizabeth; Kiss, Nicole
• Other Names: Burden Sorrel guestEditor.; Shaw Clare guestEditor.; Barlow Rachael guestEditor.
• Is Part Of: Journal of human nutrition and dietetics. Volume 36:Issue 2(2023)
• Page Start: 468
• Page End: 478
• Publication Date: 2022-04-11
• Subjects: dietitian -- gastrointestinal cancer -- malnutrition -- nutrition care pathway -- outpatient; Dietetics -- Periodicals; Nutrition -- Periodicals; 613.205
• DOI: 10.1111/jhn.13006
• Languages: English
• ISSNs: 0952-3871

Abstract

Abstract: Background: The present study aimed to investigate health service nutrition practices of sites providing care to patients undergoing surgery for upper gastrointestinal cancer within Australia, including the provision of perioperative nutrition support services and outpatient clinics, as well as the use of evidence‐based nutrition care pathways/protocols. Secondary aims were to investigate associations between the use of a nutrition care pathway/protocol and patient outcomes. Methods: Principal investigator dietitians for the sites ( n = 27) participating in the NOURISH point prevalence study participated in a purpose‐built site‐specific survey regarding perioperative nutrition practices and protocols. Data from the 200 patients who participated in the study (including malnutrition prevalence, preoperative weight loss and receipt of dietetics intervention, intraoperative feeding tube insertions, provision of nutrition support day 1 post surgery, length of stay, and complications) were investigated using multivariate analysis to determine associations with the sites' use of a nutrition care pathway/protocol. Results: The majority of sites (>92%) reported having dietetics services available in chemotherapy/radiotherapy. Eighty‐five percent of sites reported having some form of outpatient clinic service; however, a routine service was only available at 26% of sites preoperatively and 37% postoperatively. Most preoperative services were embedded into surgical/oncology clinics (70%); however, this was reported for only 44% of postoperative clinics. Only 44% had a nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, as well as higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions, and European Society of Clinical Nutrition and Metabolism (ESPEN) guideline compliant care day 1 post surgery. Conclusions: The results of the present study demonstrate varied perioperative outpatient nutrition services in this high‐risk patient group. The use of nutrition care pathways and protocols was associated with improved patient outcomes. Key points: Perioperative nutrition support is strongly recommended for patients undergoing surgery for upper gastrointestinal cancer. However, the level of perioperative nutrition services in Australia including the use of outpatient clinics and nutrition care pathways is currently unknown. Data from the 27 hospitals, and the 200 patients who participated in the NOURISH point prevalence study was analysed to report on health service nutrition practices in UGI cancer resection, and associations with patient outcomes. Results demonstrated inconsistent nutrition support practices, with 44% of sites having an evidence‐based nutrition care pathway/protocol in place. The use of a nutrition care pathway/protocol was associated with lower rates of malnutrition, and higher rates of preoperative dietetics intervention, intraoperative feeding tube insertions and ESPEN guideline compliant nutrition care day one post surgery. Abstract : Data utilised in this study of health service nutrition practices and associations with clinical outcomes in patients undergoing resection for upper gastrointestinal cancer.