In 1974, Dr. Charles Butterworth used the phrase “The Skeleton in the Hospital Closet” to raise awareness of physician and hospital induced malnutrition (iatrogenic malnutrition) in patients.1 The premise was that patients came into the hospital and became malnourished because of a variety of reasons including fluid and food withdrawal prior to surgery or diagnostic tests, failure to assess the patient, failure to monitor food intake, and others. Failure to maintain the nutritional stature of the patient through hospitalization and after are causes of longer length of stay, poor outcomes, and early return to hospital.
With the new enhanced recovery protocols post-surgery, “patients still can’t eat after midnight before an early morning surgery, but two or three hours before surgery they do get a carbohydrate-loaded drink fortified with electrolytes, minerals and vitamins. They are pretreated for pain with non-narcotic painkillers and epidurals that are kept in place postoperatively. With careful monitoring, patients receive only necessary levels of IV fluid during surgery. Soon afterward they get out of bed to walk and may ingest solid food, and they are discharged earlier with careful instructions for home care.”
Another surgeon, Dr. Hedrick, who is the co-author of a study published online in February in the Journal of the American College of Surgeons, “found that the new protocol, used in colorectal-surgery patients at the UVA health system, helped reduce the length of hospital stay by 2.2 days compared with a control group who had conventional treatment. It also reduced complications by 17% and increased patient satisfaction with pain control by 55%. There was a cost savings of $7,129 per patient.”
Dr. Butterworth also noted that nutrition education is critical to physicians understanding the risk to their patients. It has taken quite a few years, but, finally it appears that the lessons may have been learned. An article in the Wall Street Journal (March 31, 2015) by Laura Landro discusses the concept of “enhanced recovery” which is a method to reduce the stress on patients while reducing the potential for “surgery procedure induced malnutrition.” Shortening the fasting time before surgery and feeding as soon as tolerable after surgery are hallmarks of the enhanced recovery process. Many studies have shown that proper nutrition during hospitalization shortens length of stay, improves patient outcome, and helps prevent readmissions.
It is too bad that it has taken such a long time for the implementation of the holistic approach to patient care.Sources: 1 Butterworth C. The skeleton in the hospital closet. Nutr Today. 1974;9: 4-8. 2 Thiele, RH, et al., 2015. Standardization of Care: Impact of an Enhanced Recovery Protocol on Length of Stay, Complications, and Direct Costs after Colorectal Surgery. J. Am. College of Surgeons, 220:4 430–443. http://www.wsj.com/articles/patients-bounce-back-faster-from-surgery-with-hospitals-new-protocol-1427739292