背景:增强术后恢复(ERAS)护理途径包括旨在加速术后恢复的循证项目。跨学科是ERAS计划的关键点之一。
目的:准备西班牙内分泌与营养学会(SEEN)和西班牙多模式康复小组(GERM)营养领域成员的共识文件,其中目标是使ERAS计划中包含的患者的营养和代谢管理均质化。
方法:69名内分泌学和营养学专家和85名GERM成员参与了该项目。经过文献综述,提出了79项声明,分为5个部分:17个一般特征,28指的是术前时期,4到术中,13到围手术期和17到术后期。共识的程度是通过两个循环的德尔菲过程确定的,该过程通过一致性分析获得批准。
结果:总体而言,在79份声明中,有61份是一致的,SEEN成员(64/79)之间的共识程度高于GERM成员(59/79)。在没有达成一致协议的18项声明中,我们应该强调一些重要的营养策略,如肌肉质量评估,开始早期口服喂养或药物营养。
结论:就ERAS计划中的绝大多数营养措施和护理达成了共识。由于在某些关键点上缺乏共识,有必要继续与两个社会紧密合作,以改善手术患者的康复。
BACKGROUND: The Enhanced Recovery After Surgery (ERAS) care pathways include evidence-based items designed to accelerate recovery after surgery. Interdisciplinarity is one of the key points of ERAS programs.
OBJECTIVE: To prepare a
consensus document among the members of the Nutrition Area of the Spanish Society of Endocrinology and Nutrition (SEEN) and the Spanish Group for Multimodal Rehabilitation (GERM), in which the goal is to homogenize the nutritional and metabolic management of patients included in an ERAS program.
METHODS: 69 specialists in Endocrinology and Nutrition and 85 members of the GERM participated in the project. After a literature review, 79 statements were proposed, divided into 5 sections: 17 of general characteristics, 28 referring to the preoperative period, 4 to the intraoperative, 13 to the perioperative and 17 to the postoperative period. The degree of
consensus was determined through a Delphi process of 2 circulations that was ratified by a consistency analysis.
RESULTS: Overall, in 61 of the 79 statements there was a consistent agreement, with the degree of
consensus being greater among members of the SEEN (64/79) than members of the GERM (59/79). Within the 18 statements where a consistent agreement was not reached, we should highlight some important nutritional strategies such as muscle mass assessment, the start of early oral feeding or pharmaconutrition.
CONCLUSIONS: Consensus was reached on the vast majority of the nutritional measures and care included in ERAS programs. Due to the lack of agreement on certain key points, it is necessary to continue working closely with both societies to improve the recovery of the surgical patients.