4. Discussion
critically ill
FRAGILITY, DISEASE, CRITICALLY ILL, POSTOPERATIVE COMPLICATIONS
In the current study, the intervention group with active nutritional provision received nutritional support closer to the targeted goals and exhibited better clinical outcomes, including postoperative complications and mortality. High mNUTRIC scores were associated with higher mortality rates, whereas the active nutritional intervention was linked to lower mortality rates. However, the implementation status of either energy or protein intervention alone was not significantly associated with mortality outcomes.Postoperative patients undergo a state of significant stress, which has the potential to profoundly affect their physiologic responses [Additionally, regarding the actual nutrient provision to patients based on interventions, the control group received less than half of the targeted energy and protein, whereas the intervention group received an average energy of 22 kcal/kg/day and protein of 1.17 g/kg/day. The findings from the 2014 International Nutrition Survey from 187 ICUs worldwide revealed that ICU patients received only 62% of the prescribed calories and 55% of the prescribed protein [Another interesting finding of the study was the significance of mNUTRIC scores as a predisposing factor for both in-hospital and 60-day mortality after surgery. Various nutritional screening and assessment tools have been used for critically ill patients. The American Society for Parenteral and Enteral Nutrition guidelines suggest the use of nutritional risk screening (NRS) 2002 or NUTRIC scores to determine nutritional risk, while the European Society of Clinical Nutrition and Metabolism guideline disagrees with categorizing patients according to NRS 2002 or NUTRIC scores to define their nutritional regimen due to the lack of a gold standard for identifying at-risk patients [Despite our interesting findings, it is important to interpret the results with caution due to certain limitations. Firstly, there was an uneven dropout rate between the two groups, resulting in imbalances in some baseline variables such as age, gender, and SOFA score. These imbalances may have introduced bias into the estimates or influenced the results. However, it is worth noting that all baseline nutritional status measurements, including mNUTRIC scores, SGA, and BMI, were balanced between the two groups, which helped to mitigate some of the potentially confounding effects. Additionally, imbalanced characteristics related to host fragility or disease severity, such as age or SOFA scores, were found to be more unfavorable in the intervention group. However, our results showed that the clinical outcomes were superior in the intervention group. Thus, it can be expected that the impact of confounding due to these baseline differences on the final result would be insignificant. Secondly, caloric prescriptions in the current study were determined using weight-based formulas rather than indirect calorimetry, which may pose a risk of overfeeding or underfeeding. However, considering that most surgical patients were not on mechanical ventilation, the use of indirect calorimetry for these patients may have been limited. Lastly, our study enrolled a small number of patients in a single institution, limiting the generalizability of the results. Further research with a larger group of patients and multicenter studies are needed to address these limitations and provide more comprehensive guidelines on the nutritional management of critically ill patients following abdominal surgery.