Podcast
Questions and Answers
What is the name of the screening tool that was specifically designed for the preoperative surgical patient?
What is the name of the screening tool that was specifically designed for the preoperative surgical patient?
Perioperative Nutrition Screen (PONS)
Which of these is NOT a factor contributing to the decline in nutritional status during a hospital stay?
Which of these is NOT a factor contributing to the decline in nutritional status during a hospital stay?
Studies from the United States and Europe show that up to two-thirds of patients admitted to hospital are either malnourished or at risk of malnutrition.
Studies from the United States and Europe show that up to two-thirds of patients admitted to hospital are either malnourished or at risk of malnutrition.
True
What are the two main types of nutritional therapy mentioned in the text?
What are the two main types of nutritional therapy mentioned in the text?
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What does the abbreviation 'ERAS' stand for?
What does the abbreviation 'ERAS' stand for?
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There is a universally accepted tool for preoperative malnutrition risk screening.
There is a universally accepted tool for preoperative malnutrition risk screening.
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Besides low body mass index (BMI), what are some other factors that the Perioperative Nutrition Screen (PONS) considers to evaluate preoperative nutritional risk?
Besides low body mass index (BMI), what are some other factors that the Perioperative Nutrition Screen (PONS) considers to evaluate preoperative nutritional risk?
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The text states that early artificial nutrition should always be considered in patients with long-term intensive care treatment.
The text states that early artificial nutrition should always be considered in patients with long-term intensive care treatment.
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The text mentions that the cumulative effect of marginal gains in nutritional therapy can lead to clinically meaningful improvements. What are the three areas where these marginal gains can be achieved?
The text mentions that the cumulative effect of marginal gains in nutritional therapy can lead to clinically meaningful improvements. What are the three areas where these marginal gains can be achieved?
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Immunonutrition primarily aims to stimulate the immune system by enriching the diet with suitable substrates.
Immunonutrition primarily aims to stimulate the immune system by enriching the diet with suitable substrates.
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Name two primary benefits of oral/enteral immunonutrition mentioned in the text.
Name two primary benefits of oral/enteral immunonutrition mentioned in the text.
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The text states that parenteral glutamine supplementation has been unequivocally proven to reduce the rate of surgical site infections.
The text states that parenteral glutamine supplementation has been unequivocally proven to reduce the rate of surgical site infections.
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Personalized nutrition focuses on tailoring therapeutic interventions to individual patient characteristics.
Personalized nutrition focuses on tailoring therapeutic interventions to individual patient characteristics.
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Study Notes
Unresolved Issues in Perioperative Nutrition
- Surgical patients are at higher risk of negative outcomes if malnourished pre-operatively.
- Optimizing nutritional status throughout the perioperative period improves surgical outcomes.
- Enhanced Recovery After Surgery (ERAS) protocols are becoming more common, but do not always prevent muscle loss.
Methodology
- Literature search in PubMed, Web of Science, Google Scholar and Cochrane Library, using specific keywords.
- Inclusion criteria: high-quality articles published since 2015, focusing on adult surgical patients.
Epidemiology
- Up to one-third of hospitalized patients are malnourished or at risk.
- Nutritional status often deteriorates during hospitalization due to illness, medication side effects, fasting for procedures, digestive issues, or wasting from diseases and disuse.
- A review suggests two-thirds of patients scheduled for gastrointestinal surgery are malnourished at admission.
- This leads to a threefold increase in postoperative complications and a fivefold in mortality.
- Only a small proportion of hospitals formally screen for malnutrition.
Identifying Surgical Patients Needing Nutritional Therapy
- Malnutrition screening should occur within 24-48 hours of admission.
- This enables the care team to assess further and refer to specialists if needed.
- Preoperative nutritional screening can identify patients at risk of malnutrition who may benefit from interventions before surgery.
- Several malnutrition screening tools exist for surgical patients (e.g., PONS).
Role of Skeletal Muscle in Surgical Outcomes
- Low muscle mass is an independent predictor of poor surgical outcomes.
- Studies using CT scans show muscle loss is linked to complications and mortality following various types of surgical procedures, including:
- Oesophagectomy
- Colectomy
- Pancreaticoduodenectomy
- Major hepatectomy
- Liver transplantation.
- Low muscle quality (fat infiltration) also correlates with negative outcomes.
Preoperative Nutritional Therapy and Prehabilitation
- ESPEN guidelines recommend nutritional therapy for malnourished or high-risk patients.
- ERAS guidelines recommend oral food supplementation for 7-10 days prior to colorectal surgery if metabolic risk is present.
- Multimodal prehabilitation before surgery (including exercise, nutrition, psychological interventions) can improve muscle mass, functionality, and reduce postoperative complications.
- Home-based prehabilitation is an option for patients with low risk of complications.
Postoperative Nutritional Therapy
- Early oral feeding is generally recommended following surgery, particularly in colorectal resection cases.
- Delaying oral intake can increase infectious complications, mortality, and hospital length of stay.
- Parenteral nutrition is appropriate if oral/enteral nutrition cannot meet 50% of requirements for more than 7 days.
- Parenteral glutamine and omega-3 fatty acids can be beneficial for some surgical patients.
Post-Discharge Nutrition and Exercise
- Surgical recovery continues after discharge, emphasizing the importance of ongoing nutritional support.
- Patients need continued nutritional support to optimize their nutrition at home.
- Exercise and nutrition support by community nursing are key to successful recovery.
- Nutritional supplementation post-discharge is recommended.
Immunonutrition
- Stimulating the immune system through dietary enrichment improves outcomes.
- Omega-3 fatty acids and arginine can potentially reduce postoperative inflammation.
- Preoperative immunonutrition can reduce complications and length of stay for some surgical patients.
Personalized Nutrition
- Personalized nutrition strategies can further improve outcomes, possibly by identifying patients for whom nutritional support will best benefit.
- Determining factors that influence individual responsiveness to nutritional therapies and biomarkers for identifying such patients are areas of ongoing investigation.
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