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Dr. Paul Wischmeyer’s research at Duke on perioperative malnutrition is a real eye-opener

In the doctor’s own words: “Malnutrition is truly an epidemic.”

Blood pressure, pulse, temperature, oxygen saturation, aspiration rate — all things continuously monitored while a patient is recovering from surgery. Is there something else vital missing? Dr. Paul Wischmeyer thinks so.

Dr. Wischmeyer, a Professor of Anesthesiology at Duke University Hospital, is pioneering a study on the crucial role of caloric intake and overall nutritional therapy for enhanced surgical recovery. Thus far, the findings are stark. In the doctor's own words: "Malnutrition is truly an epidemic."

His team’s groundbreaking research on perioperative malnutrition is uncovering very significant insights. For example, "undernourished patients or patients at risk of malnutrition are twice as likely to be readmitted within 30 days after elective surgery." This finding appears to hit home for many ostomates.

According to the study, nutrition begins playing a role in post-operative recovery even before surgery is performed. “No patient should ever have elective surgery without being screened for malnutrition,“ says Dr. Wischmeyer. He adds that nutrition screening “takes five minutes” and can have a long-lasting impact on patients.

Are we creating survivors or victims?

New research from Advocate Health Care and supported by Abbott shows nearly one-third of the 48 million Americans who undergo surgery each year are either at-risk for malnutrition or are already malnourished when admitted to the hospital. This condition is likely to worsen while they are hospitalized, leading to longer stays and a higher rate of readmission. 

If a patient requires intensive care, malnutrition becomes an even more dire concern. Due to a significant loss of weight and muscle mass, patients released from ICU might need up to 4,000 calories a day for six months to two years for optimal recovery. However, a study of post-ICU patients showed a self-regulated caloric intake of only 700 calories a day. This discrepancy can continue to plague the patient months to even years after discharge.

That’s why Dr. Wischmeyer asks such a poignant question: Are hospitals creating survivors or victims by not prioritizing nutrition’s fundamental role in recovery? The answer, for now, seems to be the latter.

So what can we do?

There is good news, though. The question posed by Dr. Wischmeyer appears to have a relatively straightforward and cost-effective solution. Data indicates that the answer to reducing hospital stays while increasing post-hospital quality of life could be as simple as oral nutrition supplements.

By supplementing a patient's diet with extra calories and protein, hospital stays have been shown to decrease dramatically. In elderly patients, oral nutrition supplements high in protein and calories reduced mortality rates by 50%. For these treatments to be successful, however, Dr. Wischmeyer says it’s essential for at-risk patients to continue taking oral nutrition supplements for at least three months following release from the hospital. 

What needs to change?

It all begins with nutritional screening and monitoring. However, even though 83% of surgeons agree that perioperative nutrition plays a key role in reducing surgical complications, only 1 in 5 hospitals have a standardized process for evaluation. It’s even known that two-thirds of gastrointestinal patients are malnourished at the time of surgery, and that malnourished patients are 5x more likely to die than well-nourished patients.

So why aren’t hospitals more focused on battling malnutrition? That focus is what Dr. Wischmeyer and his colleagues are taking action on with the Perioperative Quality Initiative. This organization is working to develop comprehensive screening guidelines for identifying at-risk patients and then optimizing nutritional support for them.

If implemented on a large-scale, the recommendations of the Perioperative Quality Index could cause a fundamental shift in the way hospitals are caring for post-operative patients. Ensuring proper nutrition would no longer be an afterthought and take its place as another vital sign on the road to recovery.

A passion for helping patients.

It’s not difficult for Dr. Wischmeyer to find his motivation for improving post-operative care. As a fellow ostomate, he has undergone over 20 major surgeries and, as a child, endured several stays in the ICU. His passion to make lives better is a testament to the irreplaceable value of turning personal challenges into a drive to help others.

To learn more about Dr. Wischmeyer's research visit Nutrition in Surgery and Critical Care at Duke Clinical Research Institute.