Impact of the nutritional risk score in fast-track colon surgery.

BACKGROUND Patients at nutritional risk reveal an increased morbidity. Fast-track (FT) programs in colonic surgery have shown reduced complications and hospital stay. We aimed to assess the effect of FT programs on patients at nutritional risk. METHODS In a randomized trial (NCT00556790), we compared complications after open colonic surgery with either a FT program or standard care (SC). A subgroup analysis was performed in 67 patients for whom a prospective nutritional risk score (NRS) was available. RESULTS The SC and FT groups did not differ regarding patient characteristics or prevalence of NRS ≥ 3 (SC 8/31, FT 7/36, p = 0.569). Patients with SC had more complications (14/31 vs. 8/36, p = 0.044) and a longer hospital stay (9 vs. 5 days, p < 0.0001). No major complication occurred in patients with an NRS <3. Patients at nutritional risk had a high complication rate regardless of SC or FT (6/8 and 5/7, respectively, p = 1.000). Median hospital stay was shorter in FT (7 (range 5-30) days) versus SC patients (14.5 (range 8-30) days, p = 0.164). CONCLUSIONS Patients with a NRS ≥ 3 have an increased postoperative morbidity even within a FT program. They should be identified by nutritional screening and might benefit from nutritional supplements.