Influence of perioperative oral nutritional supplementation on short-term efficacy of laparos-copic sleeve gastrectomy for obesity patients: a prospective study
10.3760/cma.j.cn115610-20220829-00475
- VernacularTitle:围手术期口服营养补充对肥胖症患者行腹腔镜袖状胃切除术后短期疗效影响的前瞻性研究
- Author:
Shengjun ZHANG
1
;
Na ZHANG
;
Qian CHENG
;
Qizhong CHEN
;
Lian DENG
;
Lei WANG
;
Yongtao YU
;
Shensi CHEN
Author Information
1. 宁夏医科大学总医院营养科，银川 750001
- Keywords:
Obesity;
Bariatric surgery;
Nutritional intervention;
Readmission;
Nutri-tional status;
Laparoscopy
- From:
Chinese Journal of Digestive Surgery
2022;21(11):1432-1439
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the influence of perioperative oral nutritional supple-mentation on short-term efficacy of laparoscopic sleeve gastrectomy (LSG) for obesity patients.Methods:The prospective study was conducted. The clinical data of 218 obesity patients who underwent LSG in the General Hospital of Ningxia Medical University from January 2018 to December 2021 were selected. Patients receiving perioperative oral nutritional supplementation were allocated into the experiment group, and patients receiving perioperative conventional treatment were allo-cated into the control group, respectively. Observation indicators: (1) grouping situations of the enrolled patients; (2) postoperative situations and follow-up; (3) nutrition related indicators; (4) dietary compliance; (5) weight loss related indicators. Follow-up was conducted using telephone interview, WeChat communication and outpatient examination to detect albumin (ALB), hemoglobin (HB), dietary compliance and weight loss related indicators of patients up to February 2022. Patients were followed up once every 30 days after discharge. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the indepen-dent sample t test. Measurement data with skewed distribution were represented as M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was performed using the chi-square test. Repeated measurement data were analyzed using the repeated ANOVA. Comparison of ordinal data was analyzed using the rank sum test. Results:(1) Grouping situations of the enrolled patients. A total of 218 patients were selected for eligibility. There were 42 males and 176 females, aged (32±9)years with body mass index (BMI) as (39±7)kg/m 2. Of the 218 patients, there were 109 patients in the experiment group and 109 patients in the control group. Gender(male, female), age, BMI, preoperative albumin (Alb), preoperative hemoglobin (Hb) were 17, 92, (33±9)years, (39±7)kg/m 2, (40.6±4.8)g/L, (141.7±13.9)g/L in the experiment group, versus 25, 84, (31±8)years, (39±8)kg/m 2, (40.9±4.2)g/L, (142.9±9.7)g/L in the control group, showing no signifi-cant difference in the above indicators between the two groups ( χ2=1.89, t=?1.52, 0.51, 0.40, 0.71, P>0.05). (2) Postoperative situations and follow-up. The duration of initial hospital stay, the cost of initial hospital stay were (9.1±2.9)days, (3.6±0.5)ten thousand yuan in the experiment group, versus(11.6±3.7)days, (4.9±1.0)ten thousand yuan in the control group,showing significant differences in the above indicators between the two groups ( t=5.58, 12.38, P<0.05). Of the 218 patients,119 patients were followed up,including 62 patients in the experiment group and 57 patients in the control group,with the follow up time as 31.0(range, 25.0?38.0)days. Of the 218 patients, 14 cases were read-mitted for postoperative complications. There were 2 cases in the experiment group including 1 case with nausea and vomiting and 1 case with ileus, and there were 12 cases in the control group including 10 cases with nausea and vomiting and 2 cases with gastric fistula. There was a significant difference in the readmission between the two groups ( χ2=7.63, P<0.05). The interval between readmission and initial discharge of the 14 patients was(22.0±6.7)days. (3) Nutrition related indica-tors. The Alb and Hb of the 62 patients being followed up in the experiment group were (40.4±5.5)g/L, (35.9±3.8)g/L, (45.4±2.9)g/L and (140.8±13.9)g/L, (130.5±16.9)g/L, (147.8±17.2)g/L before opera-tion, before the first discharge and one month after operation, respectively. The above indicators of the 57 patients being followed up in the control group were (41.2±3.9)g/L, (34.2±3.9)g/L, (42.7±5.3)g/L and (143.0±9.7)g/L, (122.9±12.8)g/L, (139.0±11.4)g/L before operation, before the first discharge and one month after operation, respectively. There were significant differences in change trends of Alb and Hb before operation to one month after operation between the two groups ( Fgroup=4.27, 5.72, P<0.05). There were significant differences in Alb and Hb before operation to one month after operation between the two groups ( Ftime=187.46, 85.13, P<0.05). There were interaction effects in change trends of Alb and Hb before operation to one month after operation between the two groups ( Finteraction=7.25, 9.13, P<0.05). Results of individual effect shown that there was no significant difference in the intervention effect of Alb and Hb before operation between the two groups ( t=?0.90, ?0.99, P>0.05), and there were significant differences in the intervention effect of Alb and Hb before the first discharge and one month after operation ( t=2.45, 3.34, 2.75, 3.34, P<0.05). (4) Dietary compliance. Cases with dietary complete compliance, partial compliance, non-compliance of the 62 patients being followed up in the experiment group were 28, 19, 15, respectively. The above indicators of the 57 patients being followed up in the control group were 17, 16, 24, respectively. There was a signifi-cant difference in the dietary compliance between the two groups ( Z=?2.14, P<0.05). (5) Weight loss related indicators. The body mass, body fat mass, skeletal muscle mass, body fat ratio, waist hip fat ratio, visceral fat area of the 62 patients being followed up in the experiment group were (111.0±23.0)kg, (50.0±15.0)kg, (34.0±7.0)kg, 45%±6%, 0.99±0.08, (178±53)cm 2, respectively, before opera-tion. The above indicators of the 57 patients being followed up in the control group were (108.0±22.0)kg, (49.0±13.0)kg, (33.0±7.0)kg, 45%±5%, 0.98±0.09, (174±51)cm 2, respectively, before opera-tion. There was no significant difference in the above indicators between the two groups ( t=?0.71, ?0.48, ?1.04, 0.70, ?0.80, ?0.46, P>0.05). The body mass loss, body fat mass loss, skeletal muscle mass loss, body fat ratio loss, waist hip fat ratio loss, visceral fat area loss of the 62 patients being followed up in the experiment group were 13.8(range, 11.8?16.5)kg, 7.5(range, 6.3?10.1)kg, 3.4(range, 2.5?4.6)kg, 2.05%(range, 1.19%?3.21%), 0.04(range, 0.03?0.06), 31.5(range, 24.4?41.0)cm 2, respectively, one month after operation. The above indicators of the 57 patients being followed up in the control group were 10.8(range, 8.5?13.1)kg, 5.9(range, 4.8?8.0)kg, 4.0(range, 3.0?5.2)kg, 2.0%(range, 0.75%?3.20%), 0.04(range, 0.03?0.05), 29.1(range, 21.8?37.9)cm 2, respectively, one month after operation. There were significant differences in the body mass loss and body fat mass loss between the two groups ( Z=?4.99, ?3.54, P<0.05), and there was no significant difference in skeletal muscle mass loss, body fat ratio loss, waist hip fat ratio loss, visceral fat area loss between the two groups ( P>0.05). Conclusion:Perioperative supplement of oral nutritional can reduce the incidence of post-operative complications and readmission and enhance the postoperative nutritional status and short-term efficacy of obesity patients undergoing LSG.
