Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery

• Published in: The American journal of clinical nutrition 2017-07, Vol.106 (1), p.44-51
• Main Authors: Yeung, Sophia E, Hilkewich, Leslee, Gillis, Chelsia, Heine, John A, Fenton, Tanis R
• Format: Article
• Language: English
• Subjects: Adequacy; Adult; Aged; Catabolism; Colorectal Neoplasms - surgery; Colorectal Surgery; Complications; Dietary Proteins - administration & dosage; Dietary Supplements; Digestive System Surgical Procedures - adverse effects; Energy Intake; Feeding Behavior; Food intake; Humans; Independent variables; Intestine, Large - surgery; Length of Stay; Male; Malnutrition; Middle Aged; Morbidity; Multivariable control; Nausea; Nausea - etiology; Nutrition; Nutritional Requirements; Nutritional Status; Patients; Perioperative Care; Postoperative Care - methods; Postoperative Complications; Postoperative period; Predictive control; Prospective Studies; Proteins; Recovery; Recovery (Medical); Regression analysis; Standard of Care; Stress response; Surgery; Surgical instruments
• ISSN: 0002-9165; 1938-3207
• DOI: 10.3945/ajcn.116.148619

Protein can modulate the surgical stress response and postoperative catabolism. Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care bundles that reduce morbidity. In this study, we compared protein adequacy as well as energy intakes, gut function, clinical outcomes, and how well nutritional variables predict length of hospital stay (LOS) in patients receiving ERAS protocols and conventional care. We conducted a prospective cohort study in adult elective colorectal resection patients after conventional ( = 46) and ERAS ( = 69) care. Data collected included preoperative Malnutrition Screening Tool (MST) score, 3-d food records, postoperative nausea, LOS, and complications. Multivariable regression analysis assessed whether low protein intakes and the MST score were predictive of LOS. Total protein intakes were significantly higher in the ERAS group due to the inclusion of oral nutrition supplements (conventional group: 0.33 g · kg · d ; ERAS group: 0.54 g · kg · d ; < 0.02). This group difference in protein intake was maintained in a multivariable model that controlled for differences between baseline and surgical variables ( = 0.001). Oral food intake did not differ between the 2 groups. The ERAS group had shorter LOS ( = 0.049) and fewer total infectious complications ( = 0.01). Nausea was a predictor of protein intake. Nutrition variables were independent predictors of earlier discharge after potential confounders were controlled for. Each unit increase in preoperative MST score predicted longer LOSs of 2.5 d (95% CI: 1.5, 3.5 d; < 0.001), and the consumption of ≥60% of protein requirements during the first 3 d of hospitalization was associated with a shorter LOS of 4.4 d (95% CI: -6.8, -2.0 d; < 0.001). ERAS patients consumed more protein due to the inclusion of oral nutrition supplements. However, total protein intake remained inadequate to meet recommendations. Consumption of ≥60% protein needs after surgery and MST scores were independent predictors of LOS. This trial was registered at clinicaltrials.gov as NCT02940665.