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Updates in Surgery
Published in: Updates in Surgery 3/2020

01-09-2020 | Liver Surgery | Original Article

The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol

Authors: Francesco Ardito, Quirino Lai, Emanuele Rinninella, Antonio Mimmo, Maria Vellone, Elena Panettieri, Enrica Adducci, Marco Cintoni, Maria Cristina Mele, Antonio Gasbarrini, Felice Giuliante

Published in: Updates in Surgery | Issue 3/2020

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Abstract

Background

Malnutrition in liver surgery is correlated with higher postoperative complications and longer length of hospital stay (LOHS), the same items that ERAS programs try to optimize. However, to date, standardized dietary protocols have not been defined within ERAS programs. Aim of this study was to evaluate the impact on LOHS and postoperative complications, of a personalized nutritional protocol (NutriCatt) with diet and oral branched-chain amino acid (BCAA) supplementation, adopted within the ERAS program.

Methods

1960 consecutive liver resections were performed from January 2000 to September 2018. Exclusion criteria: perihilar cholangiocarcinoma, simultaneous colorectal and liver resections. Four groups for analysis: resections before 2009 (1st period); from 2009 to 2016 (2nd period, including laparoscopic resections); between 2016 and September 2017 (ERAS); after September 2017 (ERAS + NutriCatt).

Results

LOHS declined (p < 0.0001), from a median of 10 days (1st period) to 8, 7 and 6 in 2nd period, ERAS and ERAS + NutriCatt groups, respectively. At multivariable analysis for risk of LOHS > 8 days, the 2nd period, ERAS and ERAS + NutriCatt groups showed a protective effect. These results were confirmed for both minor and major resections. LOHS was significantly lower in ERAS + Nutricatt group than in ERAS group, without increasing risk of postoperative complications, although the rate of laparoscopic resections was similar in these two groups and complexity of liver resections was significantly higher in the last period.

Conclusions

Adoption of a personalized nutritional protocol with BCAA supplementation within the ERAS program for liver resections was a safe and effective approach that may impact on reducing the LOHS.
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Metadata
Title
The impact of personalized nutritional support on postoperative outcome within the enhanced recovery after surgery (ERAS) program for liver resections: results from the NutriCatt protocol
Authors
Francesco Ardito
Quirino Lai
Emanuele Rinninella
Antonio Mimmo
Maria Vellone
Elena Panettieri
Enrica Adducci
Marco Cintoni
Maria Cristina Mele
Antonio Gasbarrini
Felice Giuliante
Publication date
01-09-2020
Publisher
Springer International Publishing
Published in
Updates in Surgery / Issue 3/2020
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-020-00787-6

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