7 results on '"Schäfer, Markus"'
Search Results
2. Early enteral vs. oral nutrition after Whipple procedure: Study protocol for a multicentric randomized controlled trial (NUTRIWHI trial)
- Author
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Joliat, Gaëtan-Romain, Martin, David, Labgaa, Ismail, Melloul, Emmanuel, Uldry, Emilie, Halkic, Nermin, Fotsing, Ginette, Cristaudi, Alessandra, Majno-Hurst, Pietro, Vrochides, Dionisios, Demartines, Nicolas, and Schäfer, Markus
- Subjects
complications ,malnutrition ,morbidity ,pancreas cancer ,pancreatoduodenectomy - Abstract
Background Malnutrition has been shown to be a risk factor for postoperative complications after pancreatoduodenectomy (PD). In addition, patients needing a PD, such as patients with pancreatic cancer or chronic pancreatitis, often are malnourished. The best route of postoperative nutrition after PD remains unknown. The aim of this randomized controlled trial is to evaluate if early postoperative enteral nutrition can decrease complications after PD compared to oral nutrition. Methods This multicenter, open-label, randomized controlled trial will include 128 patients undergoing PD with a nutritional risk screening ≥3. Patients will be randomized 1:1 using variable block randomization stratified by center to receive either early enteral nutrition (intervention group) or oral nutrition (control group) after PD. Patients in the intervention group will receive enteral nutrition since the first night of the operation (250 ml/12 h), and enteral nutrition will be increased daily if tolerated until 1000 ml/12 h. The primary outcome will be the Comprehensive Complication Index (CCI) at 90 days after PD. Discussion This study with its multicentric and randomized design will permit to establish if early postoperative enteral nutrition after PD improves postoperative outcomes compared to oral nutrition in malnourished patients. Clinical trial registration https://clinicaltrials.gov/(NCT05042882) Registration date: September 2021.
- Published
- 2022
3. Postoperative bezoar ileus after early enteral feeding
- Author
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Dedes, Konstantin J., Schiesser, Marc, Schäfer, Markus, and Clavien, Pierre-Alain
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- 2006
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4. Nutritional Status Deteriorates Postoperatively Despite Preoperative Nutritional Support.
- Author
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Grass, Fabian, Benoit, Michael, Coti Bertrand, Pauline, Sola, Josep, Schäfer, Markus, Demartines, Nicolas, and Hübner, Martin
- Subjects
MALNUTRITION ,DIET therapy ,POSTOPERATIVE period ,PREOPERATIVE period ,NUTRITIONAL status - Abstract
Background/Aims: The aim of the current study was to assess the postoperative evolution of nutritional status and to relate it with postoperative outcomes. Methods: Demographic, surgical and nutritional parameters were assessed 10 days preoperatively (d-10) and 30 days postoperatively (d30) in 146 patients. Risk factors responsible for perioperative (>5% between d-10 and d30) weight loss were identified. Overall, severe (Clavien 3-5) and infectious complications were compared in patients with and without perioperative weight loss (>5%). Results: Nutritional status worsened beyond the postoperative period as reflected by decreasing weight (67 ± 13 kg at d-10 vs. 63 ± 13 kg at d30, p < 0.001), body mass index (23.4 ± 4 vs. 22.2 ± 4 kg/m 2, p < 0.001) and mid upper-arm muscle circumference (MAMC, 241 ± 32 vs. 232 ± 30 mm, p < 0.001). Fifty-two patients (46%) lost >5% of their body weight between d-10 and d30. Patients who presented overall (63 vs. 36%, p = 0.004) and major (27 vs. 10%, p = 0.016) postoperative complications were at significantly higher risk to deteriorate postoperative nutritional status. Multivariate analysis identified low preoperative lean body mass (OR 3.2; 95% CI 1.2-8.9, p = 0.023) and low preoperative MAMC (OR 2.5; 95% CI 0.9-6.8, p = 0.066) as independent risk factors for perioperative weight loss. Conclusions: These data suggest continuing nutritional follow- up after the index hospitalization. [ABSTRACT FROM AUTHOR]
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- 2016
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5. Preoperative nutritional screening by the specialist instead of the nutritional risk score might prevent excess nutrition: a multivariate analysis of nutritional risk factors.
- Author
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Grass, Fabian, Hübner, Martin, Schäfer, Markus, Ballabeni, Pierluigi, Cerantola, Yannick, Demartines, Nicolas, Pralong, François P., and Bertrand, Pauline Coti
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NUTRITION research ,HEALTH ,MULTIVARIATE analysis ,ANALYSIS of variance ,STATISTICS - Abstract
Background: The aim of the current study was to assess whether widely used nutritional parameters are correlated with the nutritional risk score (NRS-2002) to identify postoperative morbidity and to evaluate the role of nutritionists in nutritional assessment. Methods: A randomized trial on preoperative nutritional interventions (NCT00512213) provided the study cohort of 152 patients at nutritional risk (NRS-2002 ≥3) with a comprehensive phenotyping including diverse nutritional parameters (n=17), elaborated by nutritional specialists, and potential demographic and surgical (n=5) confounders. Risk factors for overall, severe (Dindo-Clavien 3-5) and infectious complications were identified by univariate analysis; parameters with P<0.20 were then entered in a multiple logistic regression model. Results: Final analysis included 140 patients with complete datasets. Of these, 61 patients (43.6%) were overweight, and 72 patients (51.4%) experienced at least one complication of any degree of severity. Univariate analysis identified a correlation between few (≤3) active co-morbidities (OR=4.94; 95% CI: 1.47-16.56, p=0.01) and overall complications. Patients screened as being malnourished by nutritional specialists presented less overall complications compared to the not malnourished (OR=0.47; 95% CI: 0.22-0.97, p=0.043). Severe postoperative complications occurred more often in patients with low lean body mass (OR=1.06; 95% CI: 1-1.12, p=0.028). Few (≤3) active co-morbidities (OR=8.8; 95% CI: 1.12-68.99, p=0.008) were related with postoperative infections. Patients screened as being malnourished by nutritional specialists presented less infectious complications (OR=0.28; 95% CI: 0.1-0.78), p=0.014) as compared to the not malnourished. Multivariate analysis identified few co-morbidities (OR=6.33; 95% CI: 1.75-22.84, p=0.005), low weight loss (OR=1.08; 95% CI: 1.02-1.14, p=0.006) and low hemoglobin concentration (OR=2.84; 95% CI: 1.22-6.59, p=0.021) as independent risk factors for overall postoperative complications. Compliance with nutritional supplements (OR=0.37; 95% CI: 0.14-0.97, p=0.041) and supplementation of malnourished patients as assessed by nutritional specialists (OR=0.24; 95% CI: 0.08-0.69, p=0.009) were independently associated with decreased infectious complications. Conclusions: Nutritional support based upon NRS-2002 screening might result in overnutrition, with potentially deleterious clinical consequences. We emphasize the importance of detailed assessment of the nutritional status by a dedicated specialist before deciding on early nutritional intervention for patients with an initial NRS-2002 score of ≥3. [ABSTRACT FROM AUTHOR]
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- 2015
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6. Assessment of a novel screening score for nutritional risk in predicting complications in gastro-intestinal surgery.
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Schiesser, Marc, Müller, Sven, Kirchhoff, Philipp, Breitenstein, Stefan, Schäfer, Markus, and Clavien, Pierre-Alain
- Abstract
Summary: Background & aims: Malnutrition is a recognized risk factor for perioperative morbidity, but there is currently no standardized definition of malnutrition. The Nutrition Risk Screening 2002 score was recently proposed to identify patients at nutritional risk who may benefit from nutritional support therapy, and has been officially adopted by the European Society of Parenteral and Enteral Nutrition. The aim of this study was to assess the value of the Nutrition Risk Screening 2002 score in predicting the incidence and severity of postoperative complications in gastrointestinal surgery. Methods: We prospectively evaluated 608 patients admitted for elective gastrointestinal surgery. Nutritional risk was defined by the Nutrition Risk Screening 2002 score and correlated to the incidence and severity of postoperative complications. Complications were classified using an established surgical complication classification. Results: The overall incidence of nutritional risk was 14%. We observed a significantly higher complication rate of 40% (35 out of 87) in patients at nutritional risk, compared to 15% (81 out of 521) in patients with a normal score (p <0.001). The incidence of severe complications was significantly higher in patients at nutritional risk (54% versus 15%; p <0.001). The odds ratio to develop a complication was 2.8 in patients at risk (p =0.001), and 3.0 in patients with malignant disease (p <0.001). The median length of stay in nutritional risk patients was significantly longer (10 versus 4 days, p <0.001). Conclusion: The prevalence of nutritional risk patients in gastrointestinal surgery is high. We showed that nutritional risk screening using the NRS 2002 strongly predicts the incidence and severity of complications. [Copyright &y& Elsevier]
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- 2008
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7. Preoperative immunonutrition for esophageal cancer.
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Martin, David, Mantziari, Styliani, Hübner, Martin, Winiker, Michael, Allemann, Pierre, Demartines, Nicolas, and Schäfer, Markus
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TREATMENT of esophageal cancer , *PREOPERATIVE care , *ESOPHAGECTOMY , *SURGICAL complications , *CANCER immunotherapy , *IMMUNONUTRITION diet - Abstract
Abstract Introduction Preoperative malnutrition is a demonstrated risk factor for adverse outcomes after esophagectomy. Optimizing patients' nutritional and immunological status may have beneficial impact. Objective The aim of the present study was to evaluate the impact of preoperative oral immunonutrition (IN) on postoperative outcomes after oncological esophagectomy. Methods Retrospective single-centre study of consecutive patients operated for esophageal cancer between 2011-2015. IN was introduced in our institution in 2013 and was given 7 days preoperatively. IN patients were compared to a control group in terms of postoperative complications, mortality and length of stay. Results Thirty-eight IN patients were compared to 38 control patients, with comparable baseline characteristics. Seven (19%) and 11 (31%) patients were malnourished preoperatively in IN and control groups respectively (P = 0.209). Overall complication rate was 74% in the IN group and 68% in the control group (P = 0.801). Major complications occurred in 13 patients (34%) in the IN versus 8 patients (21%) in the control group (P = 0.192) and there was no significant difference in terms of mortality (respectively 11 vs. 3%, P = 0.358). Median length of stay was significantly higher in the IN group (24 days, IQR 14-53) than in controls (16 days, IQR 12-23, P = 0.034). Conclusion A positive impact of IN on postoperative outcomes after oncological esophagectomy could not be measured. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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