Introduction Patients with oesophagogastric cancer are at high risk of malnutrition.1 The aim of this study was to assess the effect of advice provided by a dietitian peri-operatively on nutritional status at first surgical follow-up. The period studied was prior to specialist dietetic services being funded, resulting in lack of capacity to see all patients referred.
Methods Consecutive records (n=60) of patients who underwent oesophagogastric resection between August 2010 and November 2011 and referred to the dietetic service were reviewed. Jejunally (n=19) and parenterally fed (n=4), palliative (n=3), stromal tumour resection (n=1), peri-operative deaths (n=1) and incomplete records (n=1) were excluded. Anthropometrics were collected on admission and at first surgical outpatient follow-up. Number of consultations and time spent with a dietitian was recorded. Data for patients referred but not seen was compared to those who received dietetic input. Effect was measured as percentage weight loss. Tests for normality were performed. T-test was used to determine significance.
Results 31 patients were included in the study. All were initiated on oral nutrition post-operatively. n=21 received dietetic input and n=10 did not. Patient characteristics were similar between both groups apart from tumour differentiation (p=0.046), sex (p=0.023) and weight loss on admission (p=0.148). Mean length of stay=12.8 days (SE 1.1) and time to follow-up= 22.8 days (SE 2.2) (p=ns). Weight loss percentage at follow-up between patients seen and not seen by a dietitian was 7.87 (SE 0.70) and 11.66 (SE 1.24) respectively (p=0.008). Adjusting for sex, tumour differentiation and weight loss on admission did not effect the result (6.88 (SE 0.93), 11.49 (SE 1.07) p=0.005). In the intervention group mean reviews by a dietitian=2.4 (SE 0.3) and time spent=138 min (SE 14). Regression analysis showed a tendency for attenuation of percentage weight loss on increasing time with a dietitian (r=0.33; p=0.142).
Conclusion Dietetic advice peri-operatively significantly attenuates weight loss at first outpatient follow-up. This effect may improve with increasing time spent with a dietitian. The data supports the Improving Outcomes Guidance on access to dietetic expertise. Although not found in this study, malnutrition is known to increase readmission and hospital stay.2
Competing interests None declared.
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2. Correia MI, Waitberg DL. The impact of malnutruition on morbidity, mortality, length of stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235–9.