Perioperative artificial nutrition in elective surgery: an impact study of French guidelines

Objective: In France, the consensus conference, held on 16 December 1994, produced guidelineson 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 inEngland. 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’ butinadequate 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. Conclusion: 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.