Complications After Bariatric Surgery: Survey Evaluating Impact on the Practice of Specialized Nutrition Support

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Complications After Bariatric Surgery Survey
Evaluating Impact on the Practice of Specialized
Nutrition Support

• Nutrition in Clinical Practice 22673-678,
  December 2007
• American Society for Parenteral and Enteral
  nutrition

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Bariatric Surgery

• Who?
• BMI ? 40
• Life-threatening condition related to the weight
• Conditions to consider
• Obese for at least 5 years?
• Ongoing problem with alcohol?
• Depression / psychiatric disorder?

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Statistic of Bariatric Surgery

• In US from 1999-2000
• Bariatric surgery increased (6x)
• 2.3 to 14.1 per 100,000 adults
• In 2003 103,000
• In 2006 175,000-200,000

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Complications

• Leaks from suture/staple line
• Wound infection
• Stomal obstruction/stenosis
• Pulmonary embolism
• Respiratory failure
• Bleeding
• Vomiting
• Death

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Nutrition Risks

• Iron deficiency
• Malabsorption of vitamins
• Folate
• Vitamin B12
• Thiamine
• Osteoporosis
• Protein malnutrition

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Challenges

• Nutrition support assessment
• Body size
• Rapid weight loss
• Unusual nutrient deficiencies
• Nutrition Intervention
• Difficulties in gaining enteral/vascular access
• Risks of developing metabolic complications

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Methods

• A web-based survey
• Purpose
• To characterize the impact that complications of
  bariatric surgery is having on the practice of
  specialized nutrition support
• To identify current nutrition support assessment
  and intervention methods being used
• 17 multiple-choice questions
• Population
• 3700 domestic members of A.S.P.E.N.
• A follow-up survey

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Survey Questions

1. Please identify your discipline.
2. Please identify your primary nutrition support
   practice setting.
3. Your nutrition support patient population is
   composed of
4. The amount of time I spend engaged in the
   practice of specialized nutrition support as part
   of my job each week is
5. Does the institution with which you are
   affiliated performed bariatric surgery?

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Patient Characteristics Questions

1. In the previous year, approximately how many
   patients which have consulted with you for
   nutrition care have required specialized
   nutrition support as a result of complications of
   bariatric surgery?
2. If applicable, of these bariatric surgery
   patients, approximately what percentage required
   parenteral specialized nutrition support?
3. If applicable, the most common indication for any
   kind of specialized nutrition support in
   bariatric surgery patients was

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Nutrition Counseling Questions

1. If applicable, did the bariatric surgery patients
   in your care receive counseling performed by a
   dietitian?
2. At the time of assessment for specialized
   nutrition support, for those patients who were at
   least 1 month out from surgery, can you estimate
   how many patients had not received any
   micronutrient supplementation in the month before
   evaluation?

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Nutrition Assessment/Intervention Questions

• 11. What body weight do you use to estimate
  caloric goals for bariatric surgery patients?
• 12. What body weight do you use to estimate
  protein goals for bariatric surgery patients?
• 13. What protein goals would you prescribe for
  this sample patient?
• 14. What calorie goals would you prescribe for
  this sample patient?

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• 15. What percentage of this population of
  bariatric patients required continued specialized
  nutrition support after hospital discharge?
• 16. Approximately how long was specialized
  nutrition support required in the majority of the
  bariatric surgery patients that you have worked
  with?
• 17. Specialized nutrition support
  assessments/interventions for these patients were
  provided by which clinicians in your institution?
  

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Results

• 14 response rate
• Patient Characteristics (Q 6-8)
• Indications for specialized nutrition support
• Anastomotic leak/fistula (49)
• Chronic nausea/vomiting (27)
• Severe malabsorption/diarrhea (19)
• Nutrition Counseling (Q 9-10)
• Recommended patients to receive counseling before
  and after surgery
• Patients received micronutrient supplementation
  within the month before their assessment for
  specialized nutrition support

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Results

• Nutrition Assessment / Intervention
• (Q 11-17)
• Estimating calorie goals
• Adjusted body weight (62)
• Ideal body weight (15)
• Actual weight (14)
• Estimating protein goals
• Adjusted body weight (56)
• Ideal body weight (29)
• Actual weight (8)

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Conclusion

• Encourage further research for guideline
  development regarding the best practices to
  ensure that postoperative bariatric surgery
  patients receive safe and appropriate nutrition
  support.