Elsevier

Nutrition

Volume 18, Issue 2, February 2002, Pages 207-208
Nutrition

Residents column
Perioperative nutrition support

https://doi.org/10.1016/S0899-9007(01)00760-2Get rights and content

Introduction

The prevalence of malnutrition in hospitalized patients is widespread and has been reported to range from 30% to 50%.1 Malnutrition is characterized by weight loss, hypoalbuminemia, decreased skeletal muscle mass, and reduced fat stores. Studley’s classic paper in 1936 showed a strong correlation between preoperative malnutrition and postoperative complications and mortality after major abdominal or thoracic surgery.2 There is an increased risk of postoperative nosocomial infection and multiple organ dysfunction in the malnourished patient. The time for wound healing, functional recovery, and length of hospital stay are also at risk of being significantly prolonged. Perioperative nutrition can help restore many biochemical and immunologic abnormalities to a normal state. The important queston is whether or not the use of perioperative nutrition can improve outcomes. Numerous studies have investigated the efficacy of perioperative nutrition in significantly reducing morbidity and mortality. In this column, I describe the types of perioperative nutrition, their risks and benefits, and provide recommendations for their use based on the most recent literature.

Section snippets

Indications for perioperative nutrition

Studies have shown that perioperative nutrition support in severely malnourished patients (patients with weight loss > 10% of their usual weight and serum albumin < 2.5 g/dL) significantly reduces surgical com-plications.3, 4, 5, 6 However, data to support perioperative nutrition in patients with mild to moderate malnutrition have been inconclusive. Weight loss below 10% and serum albumin levels above 2.5 g/dL are strong predictors of poor surgical outcome. Other indicators of malnutrition are

Routes of administration for nutrition support

Once the nutrition status of the patient has been evaluated and the need for perioperative nutrition has been established, it is important to evaluate the gastrointestinal tract as a route of support. The patient will not tolerate enteral feeding until a certain degree of intestinal motility has returned after surgery. A history of abdominal distention, bloating, nausea, vomiting, high nasogastric residual volumes, or the passage of flatus or stool helps one to determine the degree of forward

Immunonutrients

Since 1990, standard enteral and parenteral preparations have been modified by adding immunonutrients that can enhance systemic and local immune functions and tissue-repair processes. Arginine, ω-3 polyunsaturated fatty acids, and glutamine are immunonutrients that have been shown to reduce septic morbidity and mortality in animal models.9 Arginine enhances T-cell-mediated immune function and modulates nitrogen balance and protein synthesis. It has been shown to reverse the reduction of

Conclusion

In summary, perioperative nutrition support is beneficial in the severely malnourished patient. The enteral route is the preferred route. If the gastrointestinal tract will not tolerate enteral feeding, TPN may be warranted. Perioperative TPN has been shown to benefit severely malnourished patients when given 7 to 10 d before surgery and continued through the early postoperative period. The higher complication rate associated with TPN has been seen in all patient populations except for the

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