{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:23:23Z","timestamp":1787027003423,"version":"build-2736575974"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Parenteral nutrition (PN) is a crucial clinical therapy, particularly in surgical patients. However, due to the complex composition of PN formulations, the inappropriate use of PN remains widespread in clinical practice to date. This study established a formulary prescription-based nutrition therapy protocol and assessed the effectiveness of its implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The formulary prescription-based nutrition therapy program included the development of formulary prescriptions for PN and the establishment of a perioperative nutrition medication pathway based on the formulary prescriptions. To evaluate the effect of this protocol in clinical practice, a before-and-after cohort analysis was performed to compare PN administration modalities hospital-wide and nutrition therapy strategies in targeted surgical (general surgery and thoracic surgery) departments. Patients admitted in hospital with gastrointestinal (GI) cancers and receiving abdominal surgery during the study period were further retrospectively analyzed. Nutrition status of patients was evaluated using the levels of postoperative serum albumin and prealbumin. Recovery time and surgical or nutrition-related complications and were also collated as the clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proportion of all-in-one (AIO) admixture orders increased from 47.2 to 85.2%, while multi-bottle systems (MBSs) decreased from 52.8 to 14.8% (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01). In targeted surgical departments, the utilization rate of personalized total nutrient admixture (TNA) increased from 54.5 to 79.3% (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.01), and a concurrent shift in the approach of nutrition therapy from total parenteral nutrition (TPN) to supplemental parenteral nutrition (SPN) and total enteral nutrition (TEN). Significant benefits across the spectrum of postoperative outcomes were observed in patients with GI cancers. The average postoperative prealbumin levels were elevated on both postoperative day 3 (POD 3) and postoperative day 5 (POD 5) in the after cohort compared to the before cohort (114.40\u202f\u00b1\u202f41.95 vs. 130.09\u202f\u00b1\u202f38.55\u202fmg\/L on POD 3 and 131.45\u202f\u00b1\u202f36.88 vs. 148.02\u202f\u00b1\u202f33.69\u202fmg\/L on POD 5). In addition, the after cohort showed shorter duration of postoperative PN therapy (8.2\u202f\u00b1\u202f3.3 vs. 6.3\u202f\u00b1\u202f2.6\u202fdays) and shorter length of postoperative hospital stay (14.9\u202f\u00b1\u202f5.1 vs. 12.2\u202f\u00b1\u202f4.2\u202fdays). However, there was no significant difference in the incidences of postoperative complications between the two cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The formulary prescription-based nutrition therapy protocol can significantly enhance the rational use of PN drugs hospital-wide, optimize clinical nutrition strategies in the surgical patients, and improve short-term clinical outcomes in the patients undergoing GI cancer surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1733325","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T05:37:40Z","timestamp":1768973860000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing clinical nutrition practices: impact of a formulary prescription-based nutrition therapy protocol in surgical patients"],"prefix":"10.3389","volume":"12","author":[{"given":"Mengying","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Pharmacy, The Fourth Affiliated Hospital of Soochow University, Suzhou Dushu Lake Hospital, Medical Center of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaojiao","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, The Fourth Affiliated Hospital of Soochow University, Suzhou Dushu Lake Hospital, Medical Center of Soochow University","place":["Suzhou, Jiangsu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1056\/NEJMc2506662","article-title":"Enteral nutrition in hospitalized adults","volume":"393","author":"Finucane","year":"2025","journal-title":"N Engl J Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1016\/j.clnu.2017.06.017","article-title":"ESPEN expert group recommendations for action against cancer-related malnutrition","volume":"36","author":"Arends","year":"2017","journal-title":"Clin Nutr"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"CD008879","DOI":"10.1002\/14651858.CD008879.pub3","article-title":"Preoperative nutrition therapy in people undergoing gastrointestinal surgery","volume":"2024","author":"Sowerbutts","year":"2024","journal-title":"Cochrane Database Syst Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1097\/SLA.0000000000003256","article-title":"The impact of preoperative immune modulating nutrition on outcomes in patients undergoing surgery for gastrointestinal cancer: a systematic review and Meta-analysis","volume":"270","author":"Adiamah","year":"2019","journal-title":"Ann Surg"},{"key":"ref5","first-page":"364","article-title":"Nutritional status of elderly inpatients in China: a multicenter survey","volume":"40","author":"Cui","year":"2021","journal-title":"Chin J Geriatr"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1002\/ncp.10827","article-title":"Update on use of enteral and parenteral nutrition in hospitalized patients with a diagnosis of malnutrition in the United States","volume":"37","author":"Guenter","year":"2022","journal-title":"Nutr Clin Pract"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e2033433","DOI":"10.1001\/jamanetworkopen.2020.33433","article-title":"Evaluation of nutritional support and in-hospital mortality in patients with malnutrition","volume":"4","author":"Kaegi-Braun","year":"2021","journal-title":"JAMA Netw Open"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1002\/jpen.1864","article-title":"Nutrition support team oversight and appropriateness of parenteral nutrition in hospitalized adults: a systematic review","volume":"44","author":"Stidham","year":"2020","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"107843","DOI":"10.1016\/j.pharmthera.2021.107843","article-title":"Traditional Chinese medicine (TCM) in the treatment of COVID-19 and other viral infections: efficacies and mechanisms","volume":"225","author":"Huang","year":"2021","journal-title":"Pharmacol Ther"},{"key":"ref10","first-page":"286","article-title":"Analysis of the rationality of perioperative 427 parenteral nutritional prescriptions and the effect of clinical pharmacist intervention","volume":"37","author":"Bai","year":"2017","journal-title":"Chin J Hosp Pharm"},{"key":"ref11","first-page":"170","article-title":"Analysis of rationality and irrationality of total parenteral nutrition orders in pediatric surgery department of our hospital","volume":"8","author":"Gu","year":"2022","journal-title":"Smart Healthcare"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"4745","DOI":"10.1016\/j.clnu.2021.03.031","article-title":"ESPEN practical guideline: clinical nutrition in surgery","volume":"40","author":"Weimann","year":"2021","journal-title":"Clin Nutr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1177\/0148607114521833","article-title":"A.S.P.E.N. Clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing","volume":"38","author":"Boullata","year":"2014","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref14","first-page":"946","article-title":"Guideline for clinical application of parenteral and enteral nutrition in adults patients in China (2023 edition)","volume":"103","year":"2023","journal-title":"Natl Med J China"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4480","DOI":"10.3390\/nu14214480","article-title":"Parenteral nutrition overview","volume":"14","author":"Berlana","year":"2022","journal-title":"Nutrients"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1080\/01635581.2019.1653473","article-title":"Pre-surgical nutrition support reduces the incidence of surgical wound complications in oncological patients","volume":"72","author":"Mudarra Garcia","year":"2020","journal-title":"Nutr Cancer"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","article-title":"Guidelines for perioperative care in elective colorectal surgery: enhanced recovery after surgery (ERAS((R))) society recommendations: 2018","volume":"43","author":"Gustafsson","year":"2019","journal-title":"World J Surg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1080\/01635581.2013.741752","article-title":"The impact of nutritional status, nutritional risk, and nutritional treatment on clinical outcome of 2248 hospitalized cancer patients: a multi-center, prospective cohort study in Chinese teaching hospitals","volume":"65","author":"Pan","year":"2013","journal-title":"Nutr Cancer"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1002\/jpen.1436","article-title":"Cost, time, and error assessment during preparation of parenteral nutrition: multichamber bags versus hospital-compounded bags","volume":"43","author":"Berlana","year":"2019","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1038\/ejcn.2014.34","article-title":"The impact of parenteral nutrition preparation on bloodstream infection risk and costs","volume":"68","author":"Turpin","year":"2014","journal-title":"Eur J Clin Nutr"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"S74","DOI":"10.1002\/jpen.1737","article-title":"Use of intravenous lipid emulsions with parenteral nutrition: practical handling aspects","volume":"44","author":"Boullata","year":"2020","journal-title":"JPEN J Parenter Enteral Nutr"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2056","DOI":"10.1007\/s00268-020-05462-w","article-title":"Guidelines for perioperative care for pancreatoduodenectomy: enhanced recovery after surgery (ERAS) recommendations 2019","volume":"44","author":"Melloul","year":"2020","journal-title":"World J Surg"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1001\/jamasurg.2022.0269","article-title":"Effect of early vs late supplemental parenteral nutrition in patients undergoing abdominal surgery: a randomized clinical trial","volume":"157","author":"Gao","year":"2022","journal-title":"JAMA Surg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1320","DOI":"10.1159\/000493410","article-title":"Effects of post-surgical parenteral nutrition on patients with gastric cancer","volume":"49","author":"Jin","year":"2018","journal-title":"Cell Physiol Biochem"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2497","DOI":"10.1007\/s00520-018-4527-0","article-title":"Early 7-day supplemental parenteral nutrition improves body composition and muscle strength in hypophagic cancer patients at nutritional risk","volume":"27","author":"Caccialanza","year":"2019","journal-title":"Support Care Cancer"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1097\/PEC.0000000000002567","article-title":"Serum albumin level as a predictor of outcome in patients admitted to pediatric intensive care units","volume":"37","author":"Bekhit","year":"2021","journal-title":"Pediatr Emerg Care"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"8934","DOI":"10.1002\/cam4.4415","article-title":"Real-world prognostic factors for survival among treated patients with metastatic pancreatic ductal adenocarcinoma","volume":"10","author":"Yu","year":"2021","journal-title":"Cancer Med"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2088","DOI":"10.1080\/01635581.2021.2002920","article-title":"Is prognostic nutritional index an indicator for postoperative 90-day mortality in laparoscopic gastric cancer surgery?","volume":"74","author":"Zengin","year":"2022","journal-title":"Nutr Cancer"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"111420","DOI":"10.1016\/j.nut.2021.111420","article-title":"Good performance of the global leadership initiative on malnutrition criteria for diagnosing and classifying malnutrition in people with esophageal cancer undergoing esophagectomy","author":"Wang","year":"2021","journal-title":"Nutrition"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1097\/00152193-200505000-00056","article-title":"Prealbumin is best for nutritional monitoring","volume":"35","author":"Kuszajewski","year":"2005","journal-title":"Nursing"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.anl.2021.09.005","article-title":"Nutritional predictors of pharyngocutaneous fistula after total laryngectomy: a multivariate analytic study in a single institution","volume":"49","author":"Hemdan","year":"2022","journal-title":"Auris Nasus Larynx"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1237","DOI":"10.1007\/s00384-011-1376-4","article-title":"Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of infectious complications after colorectal surgery","volume":"27","author":"Ortega-Deballon","year":"2012","journal-title":"Int J Color Dis"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s12893-019-0582-9","article-title":"C-reactive protein elevation ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer: a retrospective study","volume":"19","author":"Tanaka","year":"2019","journal-title":"BMC Surg"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1186\/s12913-024-10964-7","article-title":"The impacts of national centralized drug procurement policy on drug utilization of medical institutions: an empirical study in a county-level hospital in China","volume":"24","author":"Li","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1007\/s11096-024-01767-1","article-title":"Impact and implications of national centralized drug procurement in China","volume":"46","author":"Wang","year":"2024","journal-title":"Int J Clin Pharm"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1733325\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:39:51Z","timestamp":1771918791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2025.1733325\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,21]]},"references-count":35,"alternative-id":["10.3389\/fnut.2025.1733325"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2025.1733325","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,21]]},"article-number":"1733325"}}