Thesis defence in the University of Oulu

Doctoral Candidate

Doctor of Medicine Heli Helminen

Faculty and research unit

University of Oulu Graduate School, Faculty of Medicine, University of Oulu Graduate School
+358 294 48 0000

Field of study

Medicine

Date and time of the thesis defence

24.1.2020 12:00

Place of the thesis defence

Auditorium of Seinäjoki Central Hospital

Topic of the dissertation

Nutritional aspects in perioperative care

Opponent

Professor Maaret Castrén, Helsinki University Hospital

Custos

Docent Juha Saarnio, Oulu University Hospital

Nutritional aspects in perioperative care

Preoperative carbohydrate loading offers advantages over fasting during the waiting time to the operating theatre. Malnutrition is decidedly prevalent in hip fracture patients and predisposes individuals to a loss of strength, decreasing functionality and increasing morbidity and mortality.

This thesis investigates the effects of preoperative carbohydrate loading and whether nutrition screening tests can detect malnutrition and determine the prognosis of recovery from hip fracture in older patients. In the first study overnight fasting was compared to overnight intravenous glucose and carbohydrate-rich drink (CHD) in the morning. The patients’ subjective feelings of wellbeing were elicited. In the second study overnight fasting was compared to CHD in day-case cholecystectomy patients.

In the observational nutrition studies status of hip fracture patients was evaluated using the Mini Nutritional Assessment (MNA) short (SF) and long version (LF), serum albumin (S-Alb) and the Nutritional Risk Screening 2002 (NRS2002). The outcomes were the length of hospitalization, readmissions, changes in mobility and living arrangements and mortality. The changes in nutritional status were evaluated after six months follow-up. Preoperative carbohydrate loading offered certain benefits over fasting, namely lesser tendency to feel thirst, hunger, weakness, tiredness and anxiety during the waiting period before going to the operating theatre. CHD relieves thirst better than intravenous carbohydrate. Day-case cholecystectomy patients did not benefit from CHD.

About half of hip fracture patients had poor nutritional status at fractura time. Poor nutritional status in the MNAs predicted prolonged hospitalization, readmissions, need for more supportive living arrangements, mobility limitations and mortality. Low S-Alb predicted mortality. There was a clear deterioration in nutritional status during follow-up. CHD is safe and may promote wellbeing while waiting for surgery. It is useless in recovery from day-case cholecystectomy. About half of hip fracture patients have poor nutritional status and this can inhibit recovery. The MNA-SF appeared to be the most useful nutritional screening test. Healthcare organizations should identify patients at nutritional risk leading to nutritional care plans.

Dissertation

Last updated: 15.1.2020