Untitled Quiz

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.