PERIOPERATIVE ARTIFICIAL NUTRITION IN ELECTIVE SURGERY - AN IMPACT STUDY OF FRENCH GUIDELINES

Objective: In France, the consensus conference, held on 16 December 19 94, produced guidelines on perioperative artificial nutrition (AN) use in patients undergoing elective surgery. The aim of this study was to assess the impact of these guidelines on practice patterns. Methods: The study was a practice pattern study with a 'before-after' design an d a control group in England. A retrospective cross-sectional sample o f adult patients undergoing elective resection of the digestive tract was collected in France and England before and after the consensus con ference. Results: Malnourished patients received postoperative AN in 9 4% of 'before' cases and 82% 'after' but inadequate preoperative AN (4 0% 'before' and 26% 'after'). Postoperative AN appeared to be overpres cribed in non-malnourished patients without prolonged postoperative fa sting (70% 'before' and 65% 'after'). In the English sample there was no significant variation in AN use between 'before' and 'after' period s. Conclusion: This study shows that clinical guidelines disseminated by consensus conference had a low impact on practice patterns in Franc e and thus confirms the need to enforce the dissemination of the guide lines.