It has been well established and documented that malnutrition is an independent negative factor associated with post-surgical complications, mortality, and prolonged hospital stay and, therefore, higher healthcare costs. In addition, malnutrition is often associated with pathologic situations such as cancer, chronic inflammation or organ dysfunction that increase the risks of surgery.1
The objectives of perioperative nutritional support are: to minimize the negative protein balance, which avoids malnutrition; to maintain immunological function, thus improving postoperative recovery; to reduce intestinal function recovery time; and, to shorten hospital stay.2
In recent years, many changes have been proposed for the preoperative management of surgical patients to aid in faster recovery. The most revolutionary idea has probably been “fast-track surgery”, which has meant that the classical indications for nutritional support have been restricted to an ever-smaller group of post-surgical patients.3
The application of these new practices is rather heterogeneous, probably due to the fact that it is a process that goes beyond classic nutrition and entails changes in anesthesia management, hydration, analgesia, surgical techniques and immediate post-op patient management.
In this scenario, specialized nutritional support is reserved for malnourished patients with a high risk for developing post-surgical complications that are identified as having had a weight loss of more than 5%–10% in the last 3 months, low body mass indices (BMI) (≤18) or diagnoses of diseases that present with a high degree of inflammation.
In elective, scheduled surgery, regardless of the existence of specialized nutritional support teams, the surgical team itself should be able to identify malnutrition in order to try to prevent postoperative complications associated with a poor nutritional state. The identification of these patients can be done by applying basic tools such as the nutrition assessment test, BMI scales, preoperative albumin levels or a combination of these. After the identification of the malnutrition, the implementation of simple protocols could contribute, in some cases, to the arrival of the patient for surgery with a more appropriate nutritional state. As for the pre- and postoperative periods, there is also the idea of shortening the fasting times as much as possible. The recovery of digestive transit is key in the recovery of the immunological system and, therefore, essential for recovery after the procedure. Therefore, the surgical team should be proactive in identifying malnutrition and in the rational use of nutritional therapy.4
In BiomediKcal we are specialists in clinical nutrition; we can give pre and post surgery nutruional support and advice.