Perioperative artificial nutrition in elective surgery: an impact study of French guidelines.
OBJECTIVE
In France, the consensus conference, held on 16 December 1994, 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 and a control group in England. A retrospective cross-sectional sample of adult patients undergoing elective resection of the digestive tract was collected in France and England before and after the consensus conference.


RESULTS
Malnourished patients received postoperative AN in 94% of 'before' cases and 82% 'after' but inadequate preoperative AN (40% 'before' and 26% 'after'). Postoperative AN appeared to be over-prescribed in non-malnourished patients without prolonged postoperative fasting (70% 'before' and 65% 'after'). In the English sample there was no significant variation in AN use between 'before' and 'after' periods.


CONCLUSIONS
This study shows that clinical guidelines disseminated by consensus conference had a low impact on practice patterns in France and thus confirms the need to enforce the dissemination of the guidelines.
Lanoir
D
D
Départment d'Information Médicale - Hôpital de l'Hôtel-Dieu, Lyon, France.
Chambrier
C
C
Vergnon
P
P
Meynaud-Kraemer
L
L
Wilkinson
J
J
Mcpherson
K
K
Bouletreau
P
P
Colin
C
C
D000328:Adult; D000368:Aged; D003245:Consensus Statements as Topic; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures; D004739:England; D004750:Enteral Nutrition; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000628:therapy*; D019990:Perioperative Care; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies