Evaluation of an intervention to improve nutrition intakes among elective colorectal surgery patients: a mixed-methods pilot study

Abstract

Background: Timely and adequate nutrition after surgery is important. The aim of this study was to evaluate the effects of an intervention, developed using an integrated knowledge translation (iKT) approach, designed to improve oral intake among postoperative colorectal patients.

Methods: A pre/post, mixed-methods pilot study was undertaken at a tertiary teaching hospital in Australia. Patients who had undergone elective colorectal surgery and were admitted to the ward where ten nutrition-related strategies had been implemented were included. Quantitative data, including patient demographics, timing and type of nutrition consumed, and protein and energy intakes were collected pre/post intervention via chart audits, direct observations and verbal clarification. Qualitative data on patients’ (n=18) responses to the intervention were collected through one-on-one, semi-structured interviews and analyzed using inductive content analysis.

Results: A total of 64 patients were observed (30 pre- and 34 post-intervention). Significant improvements were seen for the following outcomes (presented as median (IQR), pre- vs. post-intervention): time to first dietary intake (h) (15.7(7.4-22.5) vs. 4.9(3.7-14.2)); patient energy intakes (kJ) on day one (1719(947-2200) vs. 3530(2192-5169)) and day two (2506(1071-3749) vs. 4144(2987-5889)); and patient protein intakes (g) on day one (3.3(1.8-11.2) vs. 30.3(20-45)) and day two (10.8(3.5-29.9) vs. 39.6(30.7-59.0)). Prescription of free fluids as first diet type increased from 13% to 79% pre/post-intervention. There were no significant differences in time to first solid dietary intake (h) (86.1(60.1-104.0) vs. 69.2(46.1-115.5)) and overall proportion of patients who met both their estimated energy and protein requirements while in hospital pre/post-intervention (22% vs. 37%). Patients reported positive experiences with the intervention.

Conclusion: A multifaceted intervention developed using an iKT approach has the potential to improve oral intakes among patients who undergo colorectal surgery. A larger scale trial is required to confirm these findings and assess the impact of the intervention on clinical outcomes and costs.