Effect of peri-operative high protein nutritional support on post-operative complications and costs of treatment in patients with colorectal cancer

Background: Purpose of the study was to investigate the impact of high protein oral nutrition supplement (ONS) on clinical and economical outcomes in patients with colorectal cancer (CRC).

Primary Objective of the study was to assess the effect of pre- a post-operative nutritional support on frequency of complications, rehospitalization rate and length of stay (LoS) independently of initial nutritional status of patients.

Secondary Objective was to assess the impact of nutrition support on costs of treatment.

Patients and Methods: Study group (SG; n 37) represented patients with CRC without distant metastases for whom radical surgery was indicated. Patients aged 18–80 years were included (mean age 64). Nutritional support represented daily application of 2 pieces of high protein ONS (Nutridrink Protein^®, 600kcal, 40g of protein), performed 10 days before surgery and 2 weeks postoperatively, consumed between meals.

Control group (CG; n 106) created patients with the same inclusion criteria as SG with conventional nutritional support.

Parameters monitored: wound/anastomosis dehiscence, infection in wound, re-hospitalization related to basic diagnosis, nutritional risk before and after surgery (protocol of The Working Group on Nutritional Care in Oncology, The Czech Oncology Society), nutritional status (weight, BMI) before and 1 month after surgery, (LoS, ONS consumption, patients palatability, ONS benefits for the patients, costs of treatment (procedures, materials, drugs incl. antibiotics, total costs) during hospitalization and 6 months after surgery excluding chemo/radiotherapy.

Results: 37 patients in SG were compared with 106 patients in CG. There was significant decrease of BMI before and after surgery (mean BMI 24.6 versus 25.3, respectively, p=0.014) and slow-down of loss of weight after surgery (mean 5.4% before, mean after surgery 2.5%, p=0.055).

31 patients (86.1%) liked ONS product and 33 patients (91.7%) appraised its benefits.

SG showed 2.3× lower relative occurrence of wound dehiscence, 2.9× lower relative occurrence of anastomosis dehiscence, 2.1× lower relative occurrence of infection in wound and 1.8× lower relative risk of rehospitalization. Mean LoS in SG was 9.6±5.8 days, in CG 12±6.4 days. It was approved that longer LoS determine higher total costs of hospitalization in both groups of patients (p=0.01).

All treatment expenses were significantly decreased in SG vs CG, including costs of antibiotics during hospitalization and 6 months after surgery as well (p=0.01). Patients without complications had significantly lower costs of drugs (p=0.02), including antibiotics (p=0.01) vs patients with complications. Mean total costs per 1 day in hospital was reduced by 10% in SG compare to CG. Mean total costs per 1 day in hospital in patients without complications declined to 508.4 EUR, median 443.8 EUR, compared to the group of patients with complications (mean total costs 527.2 EUR, median 548.7 EUR).

Conclusion: Pre- and post-operative nutritional intervention with high protein ONS reduces occurrence of post-operative complications, LoS and significantly reduces costs of treatment during hospitalization and 6 months after surgery as well in patients with CRC regardless of initial nutritional status. Nutridrink Protein^® was well tolerated with positive evaluation of its benefits by patients.

No conflict of interest.

Keywords:
Nutrition
cancer
complications

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