Preoperative nutrition forseverely malnourished patients in digestive surgery: A retrospective study

Summary Introduction Malnutrition increases postoperative morbidity and mortality. The objective of this study was to evaluate preoperative refeeding in malnourished patients at risk of refeeding syndrome (RS). Methodology A retrospective study, conducted between June 2016 and January 2017, reported to the CNIL, compared two groups of malnourished patients: a group of refeeding patients (RP) and a group of non-refeeding patients (NRP). The inclusion criteria were weight loss of more than 10% or albuminemia less than 35 g/L and RS risk factor. The primary endpoint was postoperative morbidity. The secondary endpoints were weight change and serum albumin over 6 months. Results Seventy-three patients (30 RP and 43 NRP) were included. At the time of initial management, median weight loss was 18% [1–71], while albuminemia was 26 g/L [13–40] in the RP group and 32.5 g/L [32–48] in the NRP group (P = 0.01). The overall postoperative morbidity rate was 88% (83% RP versus 90% NRP, P = 0.47), and there was no significant difference between the 2 groups. The rate of anastomotic complications was 4% for RP versus 26% for NRP (P = 0.03) after exclusion of liver surgery. Medium-term weight loss tended to be greater in RP (P = 0.7). Nutritional support was continued until the third postoperative month in 13% of RPs vs. no NRPs (P = 0.0002). Conclusion After preoperative renutrition, we did not observe a decrease in morbidity but rather a decrease in the rate of anastomotic complications in favor of the RP group. This study underscores the middle-term importance of nutritional management in view of preserving the benefits of preoperative renutrition.