Evaluating outcomes of a preoperative nutrition quality improvement program in oral cavity cancer patients: A retrospective analysis.
Abstract
Objective
To evaluate outcomes of a nursing-led preoperative nutrition screening and referral program in patients undergoing surgery for oral cavity squamous cell carcinoma (OCC).
Methods
A retrospective review was conducted 6 months prior to and 6 months following introduction of a nursing-led Patient-Generated Subjective Global Assessment (PG-SGA) screening tool which reflexed to a formal nutrition referral for scores ≥4. Patients diagnosed with OCC, seen in our multidisciplinary clinic, and completing intent-to-cure surgery with or without adjuvant therapy were included. Data abstracted for comparison included weight, height, nutrition referral and completion, demographics, tumor characteristics, and 30-day postoperative outcomes.
Results
73 patients were included in the study (35 pre-intervention and 38 post-intervention). Baseline characteristics, tumor characteristics, and surgery types were similar between groups. Following nutritional screening intervention, 30 patients (78.9%) received the pre-operative PG-SGA assessment and 70.0% scored ≥4 (required intervention) and 46.7% scored ≥9 (in critical need for intervention). Preoperative nutrition consult orders increased from 2.9% pre-intervention to 45.9% post-intervention (p < 0.001) and completed nutrition consults increased from 2.9% to 24.3% (p = 0.008). Completion of nutrition consultation was not associated with a delay to surgery. Median postoperative BMI loss was lower in the intervention group compared to pre-intervention group, but did not reach statistical significance. The comprehensive complication index (CCI) did not significantly differ between groups.
Conclusions
Patients presenting with OCC had a significant rate of severe to critical malnutrition. A nursing-led PG-SGA program successfully identified patients at risk of malnutrition and increased referral and consult completion. Future optimization may further improve perioperative outcomes. IMPLICATIONS FOR CLINICAL PRACTICE Standardized nursing-led preoperative nutritional screening has significant potential to identify malnutrition and optimize surgical outcomes for patients undergoing oral cavity cancer surgery. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.