Enhanced Recovery After Surgery (ERAS) Nutrition
* the opinions expressed are those of the author and not Nutrition Ink.
In recent years hospitals began to update the way in which we think about nutrition regarding surgical recovery. For the longest time the standard in treating post op patients has been to progress them along the path of clear liquid, to full liquid, to solid foods over a few days or weeks depending on tolerance. This is hopefully a soon to be antiquated strategy in post-surgery nutrition.
The current standard of placing a patient on a clear liquid diet followed by the full liquid diet has been effective but also slow to get results due to the low protein available on such diets. This is problematic due to a general patient dissatisfaction with nutrition options and the high costs of extended hospital stays. Soon we may be able to have solid food earlier, with better tolerance, and get out of the hospital faster with the gradual rollout of the ERAS (Enhanced Recovery After Surgery) protocol and diet.
Surgery in and of itself is the cause of some substantial trauma and, subsequently, metabolic stress. This stress is “characterized by postoperative insulin resistance (PIR). PIR is considered a surgical stress marker and is associated with increased morbidity and postoperative length of stay” (sanchez, 2017). This state is worsened when a post op feeding is postponed. This is where the new ERAS protocols and guidelines become involved. These guidelines focus on avoiding prolonged fasting before surgery by carbohydrate loading up to 2 hours prior. This is accompanied sometimes by early post op feeding via digestive tube. This aids in mitigating some of the effects of PIR and allows for a quicker recovery and a quicker return to a solid diet.
Studies are currently showing positive results with this new protocol and seem to be building upon it. Another study was recently performed in which ERAS protocol was followed and expanded upon with the use of “supplements enriched with immunenutrients” (Moya, 2016) 7 days before and 5 days after surgery. This addition showed a significant decrease in post op infections. Another study has shown a 3-day reduction in length of hospital stay after implementation of ERAS Protocols. Evidence continues to emerge showing the curative effects of implementing the ERAS diet, and with continued practice and research, there is a good chance we will see recoveries get shorter and shorter.
References
Moya, P., Soriano-Irigaray, L., Ramirez, J. M., Garcea, A., Blasco, O., Blanco, F. J., . . . Arroyo, A. (2016). Perioperative Standard Oral Nutrition Supplements Versus Immunonutrition in Patients Undergoing Colorectal Resection in an Enhanced Recovery (ERAS) Protocol. Medicine,95(21). doi:10.1097/md.0000000000003704
Sánchez C., Andrés, & Papapietro V., Karin. (2017). Perioperative nutrition in ERAS Protocols. Revista médica de Chile, 145(11), 1447-1453. https://dx.doi.org/10.4067/s0034-98872017001101447
Shida, D., Tagawa, K., Inada, K., Nasu, K., Seyama, Y., Maeshiro, T., … Umekita, N. (2017). Modified enhanced recovery after surgery (ERAS) protocols for patients with obstructive colorectal cancer. BMC surgery, 17(1), 18. doi:10.1186/s12893-017-0213-2
