Nutrición perioperatoria 360: un modelo de atención basado en la evidencia : Nutrición perioperatoria

Olga Lucia Pinzón Espitia; María del Pilar  Morales Huertas; Juan Guillermo  Ariza Lozano; Josef  Kling Gómez

doi:10.12873/423pinzon

Autores/as

Olga Lucia Pinzón Espitia Universidad Nacional de Colombia
María del Pilar Morales https://orcid.org/0000-0002-9393-3867 https://orcid.org/0000-0002-9393-3867
Juan Guillermo Ariza https://orcid.org/0000-0003-1170-9042
Josef Kling

DOI:

https://doi.org/10.12873/423pinzon

Palabras clave:

Arginina; Ácidos Grasos; Nucleótidos; Cirugía General; Soporte Nutricional; Análisis de Costos.

Resumen

La presente revisión de literatura permite proponer un modelo de acción para identificar oportunamente los pacientes que requieren cirugía mayor y que puedan beneficiarse de intervenciones nutricionales como la inmunonutrición a partir de la evidencia científica. Metodológicamente incluyó una revisión rápida de la literatura, a partir de la consulta en las siguientes fuentes de datos, EMBASE, MEDLINE (Pubmed), Cochrane Database of Systematic Reviews (Wiley), LILACS (BVS, interfaz iAHx) y el motor de búsqueda Google Académico. Como resultado se identificaron 40 artículos, que cumplieron con los parámetros establecidos para la revisión sistemática y los criterios de calidad, que permitieron establecer cuatro fases para la propuesta de intervención nutricional 360 en el manejo nutricional perioperatorio, tamización nutricional de rutina en consulta externa, suplementación preoperatoria con dosis terapéutica de inmunonutrición, intervención nutricional intrahospitalaria y seguimiento nutricional postoperatorio. En conclusión, un modelo de intervención nutricional que incluya un aporte nutricional con una fórmula de aminoácidos (arginina y/o glutamina), ácidos grasos poliinsaturados (ácido graso omega-3) y una mezcla de nucleótidos o ARN, es una estrategia costo- efectiva en pacientes de cirugía electiva por cáncer gastrointestinal (cáncer de estómago y colon), cirugía de cabeza y cuello, pacientes mayores 18 años.

Biografía del autor/a

María del Pilar Morales, https://orcid.org/0000-0002-9393-3867

Nutricionista - Diestista

Epidemiologa (candidata)

Juan Guillermo Ariza

Médico

Medical Affairs Leader - Improve clinical practice, advance in medical science and promote better patient and healthcare system outcomes.

Josef Kling

Médico

Especialista en Cirugía

Citas

Drover JW.; Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011;212(3):385-399.e1.

Martindale RG.; McClave SA, Taylor B, Lawson CM. Perioperative nutrition: what is the current landscape?. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):5S-20S.

Arends J.; Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11-48.

Schwegler I.; von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010;97(1):92-97.

Yu K; Zheng X, Wang G, et al. Immunonutrition vs Standard Nutrition for Cancer Patients: A Systematic Review and Meta-Analysis (Part 1). JPEN J Parenter Enteral Nutr. 2020;44(5):742-767.

Cerantola Y.; Hübner M, Grass F, Demartines N, Schäfer M. Immunonutrition in gastrointestinal surgery. Br J Surg. 2011;98(1):37-48.

Probst P.; Ohmann S, Klaiber U, et al. Meta-analysis of immunonutrition in major abdominal surgery. Br J Surg. 2017;104(12):1594-1608.

Soares AD.; Costa KA, Wanner SP, et al. Dietary glutamine prevents the loss of intestinal barrier function and attenuates the increase in core body temperature induced by acute heat exposure. Br J Nutr. 2014;112(10):1601-1610.

Efron D.; Barbul A. Role of arginine in immunonutrition. J Gastroenterol. 2000;35 Suppl 12:20-23.

Martin JM.; Stapleton RD. Omega-3 fatty acids in critical illness. Nutr Rev. 2010;68(9):531-541.

Marik PE.; Zaloga GP. Immunonutrition in high-risk surgical patients: a systematic review and analysis of the literature. JPEN J Parenter Enteral Nutr. 2010;34(4):378-386.

Mauskopf JA.; Candrilli SD, Chevrou-Séverac H, Ochoa JB. Immunonutrition for patients undergoing elective surgery for gastrointestinal cancer: impact on hospital costs. World J Surg Oncol. 2012;10:136.

Waitzberg DL.; Saito H, Plank LD, et al. Postsurgical infections are reduced with specialized nutrition support. World J Surg. 2006;30(8):1592-1604.

Dobbins, M. "Rapid review guidebook." Natl. Collab. Cent. Method Tools 13 (2017): 25.

Meijers JM.; Tan F, Schols JM, Halfens RJ. Nutritional care; do process and structure indicators influence malnutrition prevalence over time?. Clin Nutr. 2014;33(3):459-465.

Geiker NR.; Horup Larsen SM, Stender S, Astrup A. Poor performance of mandatory nutritional screening of in-hospital patients. Clin Nutr. 2012;31(6):862-867.

de Las Peñas R.; Majem M, Perez-Altozano J, et al. SEOM clinical guidelines on nutrition in cancer patients (2018). Clin Transl Oncol. 2019;21(1):87-93.

Thompson KL.; Elliott L, Fuchs-Tarlovsky V, Levin RM, Voss AC, Piemonte T. Oncology Evidence-Based Nutrition Practice Guideline for Adults. J Acad Nutr Diet. 2017;117(2):297-310.e47.

Braga M. Perioperative immunonutrition and gut function. Curr Opin Clin Nutr Metab Care. 2012;15(5):485-488.

Cheng Y.; Zhang J, Zhang L, Wu J, Zhan Z. Enteral immunonutrition versus enteral nutrition for gastric cancer patients undergoing a total gastrectomy: a systematic review and meta-analysis. BMC Gastroenterol. 2018;18(1):11. Published 2018 Jan 16.

Ida S.; Hiki N, Cho H, et al. Randomized clinical trial comparing standard diet with perioperative oral immunonutrition in total gastrectomy for gastric cancer. Br J Surg. 2017;104(4):377-383.

Song GM.; Liu XL, Bian W, et al. Systematic review with network meta-analysis: comparative efficacy of different enteral immunonutrition formulas in patients underwent gastrectomy. Oncotarget. 2017;8(14):23376-23388.

Braga M.; Wischmeyer PE, Drover J, Heyland DK. Clinical evidence for pharmaconutrition in major elective surgery. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):66S-72S.

Weimann A.; Braga M, Harsanyi L, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr. 2006;25(2):224-244.

McClave SA.; Kozar R, Martindale RG, et al. Summary points and consensus recommendations from the North American Surgical Nutrition Summit. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):99S-105S.

Ali Abdelhamid Y.; Chapman MJ, Deane AM. Peri-operative nutrition. Anaesthesia. 2016;71 Suppl 1:9-18.

Banerjee S.; Garrison LP, Danel A, Ochoa Gautier JB, Flum DR. Effects of arginine-based immunonutrition on inpatient total costs and hospitalization outcomes for patients undergoing colorectal surgery. Nutrition. 2017;42:106-113.

Ukleja A.; Gilbert K, Mogensen KM, et al. Standards for Nutrition Support: Adult Hospitalized Patients. Nutr Clin Pract. 2018;33(6):906-920.

Burden S.; Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database Syst Rev. 2012;11:CD008879.

Lewis SJ.; Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13(3):569-575.

Steed HL.; Capstick V, Flood C, Schepansky A, Schulz J, Mayes DC. A randomized controlled trial of early versus "traditional" postoperative oral intake after major abdominal gynecologic surgery. Am J Obstet Gynecol. 2002;186(5):861-865.

Lewis SJ.; Egger M, Sylvester PA, Thomas S. Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials. BMJ. 2001;323(7316):773-776.

Braga M.; Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Parenteral Nutrition: surgery. Clin Nutr. 2009;28(4):378-386.

McClave SA.; Martindale R, Taylor B, Gramlich L. Appropriate use of parenteral nutrition through the perioperative period. JPEN J Parenter Enteral Nutr. 2013;37(5 Suppl):73S-82S.

Yanok RMP.; SA IIM, Chau SH, SENG KJSM. A Systematic Review on the Effectiveness of Enteral Immunonutrition (EIN) on Pre-and Post-Operative Outcomes in Gastric Cancer Patients. 2020;49(3):625-34.

Xu J.; Sun X, Xin Q, et al. Effect of immunonutrition on colorectal cancer patients undergoing surgery: a meta-analysis. Int J Colorectal Dis. 2018;33(3):273-283.

Braga M.; Gianotti L. Preoperative immunonutrition: cost-benefit analysis. JPEN J Parenter Enteral Nutr. 2005;29(1 Suppl):S57-S61.

Barreiro E.; Sánchez R, Diz S, Piñeiro A, Seoane J, Carrera E. Impacto de la terapia con inmunonutrición oral perioperatoria en pacientes sometidos a cirugía por cáncer colorrectal [Impact of preoperative oral nutrition therapy in patients undergoing surgery for colorectal cancer]. Nutr Hosp. 2019;36(5):1150-1156.

Weimann A.; Braga M, Carli F, et al. ESPEN practical guideline: Clinical nutrition in surgery. Clin Nutr. 2021;40(7):4745-4761.

Fujitani K.; Tsujinaka T, Fujita J, et al. Prospective randomized trial of preoperative enteral immunonutrition followed by elective total gastrectomy for gastric cancer. Br J Surg. 2012;99(5):621-629.

Marano L.; Porfidia R, Pezzella M, et al. Clinical and immunological impact of early postoperative enteral immunonutrition after total gastrectomy in gastric cancer patients: a prospective randomized study. Ann Surg Oncol. 2013;20(12):3912-3918.

Reeves C.; Deeks J, and Higgins J.P. "13 Including non-randomized studies." Cochrane handbook for systematic reviews of interventions 1 (2008): 391.

Williams D.; Molinger J, Wischmeyer P. The malnourished surgery patient: a silent epidemic in perioperative outcomes?. Curr Opin Anaesthesiol. 2019;32(3):405-411.

Nutrición perioperatoria 360: un modelo de atención basado en la evidencia