Multidisciplinary consensus on nutritional and metabolic therapy in enhanced recovery after abdominal surgery programs: NutRICA Project

• Published in: Endocrinología, diabetes y nutrición. diabetes y nutrición., 2022-02, Vol.69 (2), p.98-111
• Main Authors: Ocón Bretón, M. Julia, Tapia Guerrero, M. José, Ramírez Rodriguez, José Manuel, Peteiro Miranda, Carlos, Ballesteros Pomar, María D., Botella Romero, Francisco, Martínez Olmos, Miguel Ángel, Luengo Pérez, Luis Miguel, Cancer Minchot, Emilia, García Malpartida, Katherine, López Gómez, Juan José, Zugasti Murillo, Ana, Álvarez Hernández, Julia, Bretón Lesmes, Irene
• Format: Article
• Language: English
• Subjects: Ayuno preoperatorio; Bebidas ricas en hidratos de carbono; Carbohydrate rich beverages; Consensus; Enhanced recovery after abdominal surgery; Humans; Immunonutrition; Inmunonutrición; Nutritional therapy; Postoperative Period; Preoperative fasting; Recuperación intensificada en cirugía abdominal; Terapia nutricional
• ISSN: 2530-0180; 2530-0180
• DOI: 10.1016/j.endien.2021.02.005

The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs. To prepare a consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program. 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis. Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition. Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients. La recuperación Intensificada en cirugía abdominal (RICA), constituye un conjunto de estrategias perioperatorias encaminadas a acelerar la recuperación del paciente. La interdisciplinariedad es uno de los puntos claves de los programas RICA. Elaborar un documento de consenso entre los miembros del Área de Nutrición de la Sociedad Española de Endocrinología y Nutrición (SEEN) y del Grupo Español de Rehabilitación Multimodal (GERM), donde se intente homogeneizar el manejo nutricional y metabólico de los pacientes incluidos en un programa RICA. Han participado 69 especialistas en Endocrinología y Nutrición y 85 miembros del GERM. Tras una revisión bibliográfica fueron propuestas 79 aseveraciones divididas en 5 apartados: 17 de carácter general, 28 referidas al preoperatorio, 4 al intraoperatorio, 13 al perioperatorio y 17 al postoperatorio. Se deter