To Feed or Not to Feed – Nutritional Risk Assessment and Support in Elective Colorectal Surgery. A Prospective Study on the Effect of Screening

Abstract

Colorectal cancer (CRC) is the third most common malignant tumor and resection remains the key element in its treatment. The correction of preoperative malnutrition reduces morbidity and mortality. Our study demonstrates a nutritional state mass screening protocol to steer nutritional support. Two hundred fifty-nine patients with planned colorectal resection were prospectively enrolled. Preoperative telemedicinal assessment determined the risk of malnutrition using Nutritional Risk Screening 2002 (NRS 2002) score. Patients with a score ≥3 were offered optimized oral nutritional supplement. Three groups were investigated. Group I (NRS 2002 < 3, n = 98) received no supplement. Group II- (NRS 2002 ≥ 3, n = 118) was offered but did not finally receive clinical nutrition. Group II+ (NRS 2002 ≥ 3, n = 43) accepted and received adequate clinical nutrition. 98 patients (37.8%) had no risk, 154 patients (59.5%) had increased risk and 7 (2.7%) had severe malnutrition. Severe complications (Clavien-Dindo >2) rate was similar in Group I (2%) and Group II+ (2.3%) with no mortality. Severe complications more often occurred in Group II- (5.1%) along with 1.7% mortality (p > 0.05). Length of stay was the highest in Group II- while the lowest in Group II+ (p < 0.01). Preoperative telemedicinal screening is applicable in identifying patients with malnutrition. NRS 2002 used by a nutritional team reduces length of stay.

Acknowledgments

The authors are grateful to Krisztina Gyurkovics and Katalin Horváth dietitians for the expert nutritional workup. We would like to express gratitude to Tímea Geyer and Fruzsina Tóth for the extensive administration, along with Béla Barabás and Ákos M Lőrincz for their help with the statistical design and evaluation.

Disclosure Statement

The authors report no conflict of interest.

No potential competing interest was reported by the authors.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

The authors confirm that there are no relevant financial or non-financial competing interests to report.

Authors’ Contributions

KD: conceptualization, methodology, investigation, writing – original draft

BTZ: project administration, investigation

DA: investigation, formal analysis

MFT: conceptualization, writing – review and editing

OA: supervision, validation

All authors have read and approved the final version of the paper.

Funding

The author(s) reported there is no funding associated with the work featured in this article.