The malnourished surgery patient

Abstract

Purpose of Review: As many as 2 of every 3 major surgery patients are malnourished preoperatively-a diagnosis rarely made and treated even less frequently. Unfortunately, perioperative malnutrition is perhaps the least often identified surgical risk factor and is among the most treatable to improve outcomes. Recent findings: Two important perioperative nutrition guidelines were published recently. Both emphasize nutrition assessment as an essential component of preoperative screening. The recently published Perioperative Nutrition Screen (PONS) readily identifies patients at malnutrition risk, allowing for preoperative nutritional optimization. The use of CT scan and ultrasound lean body mass (LBM) evaluation to identify sarcopenia associated with surgical risk and guide nutrition intervention is garnering further support. Preoperative nutrition optimization in malnourished patients, use of immunonutrition in all major surgery, avoidance of preoperative fasting, inclusion of post-operative high-protein nutritional supplements, and early postoperative oral intake have all recently been shown to improve outcomes and should be utilized. Summary: The recent publication of new surgical nutrition guidelines, the PONS score and use of LBM assessments will allow better identification and earlier intervention on perioperative malnutrition. It is essential that in the future no patient undergoes elective surgery without nutrition screening and nutrition intervention when malnutrition risk is identified.

Tutorial: Development and Implementation of a Multidisciplinary Preoperative Nutrition Optimization Clinic

“…“The malnourished surgery patient: a silent epidemic in perioperative outcomes?” 31 Review article on demographics and treatment strategies for surgical malnutrition.…”

Influence of nutritional status in the postoperative period of patients with inflammatory bowel disease

“…Postoperative complications are frequent in IBD, especially intra-abdominal sepsis, surgical site infection (SSI), and adynamic ileum[ 5 - 9 ]. Increased understanding of the effects of nutritional status on surgical outcomes and the patient characteristics that are predictive of surgery-associated complications are essential for prompt implementation of adequate nutritional interventions[ 10 ]. The purpose of this review was to gather scientific evidence on the influence of nutritional status in the postoperative period of people with IBD.…”

Impact of Artificial Nutrition on Postoperative Complications

“…Surgical trauma induces hormonal, hematological, metabolic, and immunologic changes aimed to counteract the state of stress that challenges metabolic and physiologic equilibrium [ 10 , 11 ]. The stress response and tissue injury are strictly related; an enhanced stress reaction can lead to major adverse consequences including catabolism, hyperglycemia and immunosuppression ( Figure 2 ).…”

“…Data from the National Surgical Quality Improvement Program (NSQIP) demonstrate that malnutrition is among the first 10 preoperative risk factors leading to a poor outcome or increased mortality [ 9 ]; moreover, among the main causes of postoperative mortality malnutrition is the only identifiable and modifiable factor. It is estimated that around 30% of patients are malnourished at hospital admission, and the Healthcare Cost, and Utilization Project (HCUP) indicates that only 3% of these patients are properly identified during their hospitalization [ 10 ]. The HCUP project reveals also that fewer than 7% of malnutrition-related hospital stays are submitted to specific and significant nutritional interventions.…”