Impact of a Geriatric Intervention to Improve Screening and Management of Undernutrition in Older Patients Undergoing Surgery for Colorectal Cancer: Results of the ANC Stepped-Wedge Trial

Nutrients

ANC Working Group¹  Thomas Gilbert²  Marc Bonnefoy²  Evelyne Decullier³  Laurent Villeneuve³  Sylvie Bin-Dorel³  Lorraine Bernard³  Marine Alexandre³ 

[1] ;Geriatric Medicine Department, Hospices Civils de Lyon, Groupement Hospitalier Sud, CEDEX, 69495 Pierre-Bénite, France;Public Health Department, Epidemiology and Clinical Research Unit, Hospices Civils de Lyon, 69002 Lyon, France;

关键词: neoplasms;    preoperative care/methods;    enteral nutrition;    aged;   

DOI  :  10.3390/nu13072347

来源: DOAJ

【 摘 要 】

Almost two in three patients who are aged 75 years and older and scheduled for surgery for colorectal cancer (CRC) are undernourished. Despite evidence that perioperative nutritional management can improve patients outcomes, international guidelines are still insufficiently applied in current practice. In this stepped-wedge cluster-randomized study of five surgical hospitals, we included 147 patients aged 70 years or older with scheduled abdominal surgery for CRC between October 2013 and December 2016. In the intervention condition, an outreach team comprising a geriatrician and a dietician visited patients and staff in surgical wards to assist with the correct application of guidelines. Evaluation, diagnosis, and prescription (according to nutritional status) were considered appropriate and strictly consistent with guidelines in 39.2% of patients in the intervention group compared to only 1.4% in the control group (p = 0.0002). Prescription of oral nutritional supplements during the perioperative period was significantly improved (41.9% vs. 4.1%; p < 0.0001). However, there were no benefits of the intervention on surgical complications or adverse events. A possible benefit of hospital stay reduction will need to be confirmed in further studies. This study highlights the importance of the implementation of quality improvement interventions into current practice for the perioperative nutritional management of older patients with CRC.

【 授权许可】

Unknown