Early oral nutritional supplementation combined with graded functional exercise for postoperative recovery in patients undergoing pancreaticoduodenectomy.

Effects of early postoperative nutritional support on enhanced recovery after lung transplantation.

Optimization of perioperative nutrition management based on the ERAS protocol for improving postoperative recovery in patients undergoing total knee arthroplasty: a prospective comparative study

Objective To investigate the clinical effects of an ERAS-based perioperative nutrition management bundle on nutritional status (indicated by prealbumin), postoperative complications (postoperative nausea and vomiting, PONV), and patient satisfaction in patients undergoing total knee arthroplasty (TKA), and to provide preliminary evidence for the standardization of ERAS nutrition protocols in orthopedic practice. Methods A total of 96 patients scheduled for TKA between January 2025 and December 2025 were allocated into two groups (control group, n = 48; nutrition group, n = 48) using an alternating assignment method based on admission order (quasi-randomization). The control group received traditional fasting regimens, while the nutrition group implemented an ERAS-optimized protocol. The primary outcome was prealbumin (PA) level on postoperative day 3; secondary outcomes included ESR, PONV, patient satisfaction, and fasting times. Results The nutrition group had significantly shorter fluid fasting time (2.08 ± 0.28 vs. 7.23 ± 3.72 h, P < 0.001). On postoperative day 1, the nutrition group showed lower ESR (11.51 ± 8.89 vs. 15.79 ± 11.41 mm/h, P = 0.043) and higher PA (199.67 ± 46.98 vs. 177.48 ± 35.32 mg/L, P = 0.011); on day 3, PA remained significantly higher (139.29 ± 37.13 vs. 125.31 ± 26.62 mg/L, P = 0.037). The incidence of PONV was lower in the nutrition group (4.17% vs. 18.75%, P = 0.025), with higher patient satisfaction (P = 0.012). A simplified multivariable logistic regression model adjusting for age confirmed the independent association between the nutrition intervention and reduced PONV (OR = 0.19, 95%CI 0.04–0.95, P = 0.043). No significant differences were observed in total blood loss, drain output, or length of hospital stay (all P > 0.05). Conclusion In this prospective comparative study, an ERAS-based perioperative nutrition protocol was associated with shorter fluid fasting time, better preservation of early postoperative prealbumin levels, a lower incidence of PONV, and higher patient satisfaction compared with traditional fasting, without increasing perioperative blood loss or prolonging hospital stay. These findings support the safety and feasibility of this protocol; however, due to the quasi-randomized design and exploratory nature of the secondary analyses, these associations should be interpreted with caution. They require confirmation in larger, randomized trials with longer follow-up and functional outcome assessment.

Early postoperative exercise enhances recovery after gastrectomy: a randomized clinical trial

Surgery for gastric cancer often leads to physical decline, delaying the return to normal life and adjuvant chemotherapy. This study evaluated whether an early, structured postoperative exercise program accelerates the recovery of physical function after gastrectomy. This two-arm randomized trial was conducted from 3 January 2023 to 25 July 2024 at a tertiary referral center in Seoul, Korea. Fifty-two patients with stage I–III gastric cancer scheduled for minimally invasive surgery were randomly assigned (1:1) to either an exercise intervention or usual care. The exercise group received hybrid supervised and unsupervised inpatient exercise sessions [15–30 minutes on postoperative days (PODs) 1 and 2], plus a 4-week home-based program that included two 30-minute supervised remote sessions weekly and daily self-directed low- to moderate-intensity aerobic and body-weight exercises. The primary outcome was the recovery of physical function, defined as a Short Physical Performance Battery score ≥100% of baseline. Secondary outcomes included C-reactive protein (CRP) levels, grip strength, sit-to-stand performance, and complications. Analyses followed intention-to-treat principles. Of 52 randomized participants, 51 (exercise, n = 26; usual care, n = 25) were analyzed and 45 (87%) completed the trial. At POD 3, 61.5% of participants in the exercise group achieved full physical function recovery compared with only 20% in the usual care group [risk ratio (RR), 3.08 (95% confidence interval [CI], 1.33–7.13); P = .006]. At 4 weeks, recovery remained significantly more likely in the exercise group (84.6% vs. 52.0%; RR, 1.63 [95% CI, 1.08–2.45]; P = .020). CRP levels were significantly lower over time in the exercise group ( P = .022). Grip strength and sit-to-stand performance did not differ between groups. No exercise-related adverse events occurred. An early, structured postoperative exercise program safely accelerated functional recovery and reduced systemic inflammation after gastrectomy in patients with gastric cancer. These findings support integrating early exercise into enhanced recovery protocols to promote earlier rehabilitation and the timely initiation of adjuvant therapy.

Early oral nutritional supplementation and postoperative recovery after hip arthroplasty in malnourished older adults with femoral neck fracture

Background Older patients with malnutrition who undergo hip arthroplasty for femoral neck fracture are at high risk of delayed postoperative recovery. This retrospective study aimed to examine the association of early oral nutritional supplementation (ONS) with postoperative nutrition-related laboratory indicators, recovery outcomes, and in-hospital complications in this population. Methods We retrospectively analyzed consecutive patients aged 60 years or older with malnutrition who underwent hemiarthroplasty or total hip arthroplasty for femoral neck fracture between January 2022 and December 2025. Patients were classified into an early ONS group if structured ONS was initiated within 24 h after surgery and into a control group otherwise. Primary outcomes included postoperative changes in serum albumin, prealbumin, hemoglobin, total protein, lymphocyte count, length of hospital stay, time to first ambulation, and time to first flatus. Secondary outcomes were postoperative complications during the index hospitalization. Results Among 294 included patients, 118 received early ONS and 176 served as controls. At discharge, the early ONS group showed more favorable laboratory profiles, including higher serum albumin [β = 1.42, 95% confidence interval (CI): 0.66 to 2.18; p < 0.001], prealbumin (β = 13.58, 95% CI: 5.92 to 21.24; p < 0.001), total protein (β = 1.76, 95% CI: 0.54 to 2.98; p = 0.005), and lymphocyte count (β = 0.11, 95% CI: 0.04 to 0.18; p = 0.002). Early ONS was also associated with shorter time to first ambulation (β = −5.38 h, 95% CI: −7.56 to −3.20; p < 0.001), shorter time to first flatus (β = −6.84 h, 95% CI: −9.53 to −4.15; p < 0.001), and shorter hospital stay (β = −1.29 days, 95% CI: −1.98 to −0.60; p < 0.001). Lower odds of pulmonary infection were observed (odds ratio = 0.46, 95% CI: 0.16 to 0.93; p = 0.041), although this finding should be interpreted cautiously because of the limited number of events. Conclusion Early ONS after hip arthroplasty in older patients with malnutrition and femoral neck fracture was associated with more favorable short-term nutrition-related laboratory profiles and faster postoperative recovery. The association with pulmonary infection warrants cautious interpretation and further validation in prospective studies.

Milk of magnesia in enhanced recovery after surgery for preventing postoperative ileus after hysterectomy: randomized controlled trial

Adding MOM to ERAS was associated with reduced POI incidence and faster recovery of bowel function in patients undergoing abdominal hysterectomy for benign or malignant conditions.

[The impact of early postoperative enteral nutrition on nutritional status and immune function in breast cancer patients after neoadjuvant therapy].

Early postoperative enteral nutrition support can effectively improve the nutritional status of breast cancer patients after neoadjuvant chemotherapy, enhance immune function to a certain extent, and promote postoperative recovery.