Perioperative Nutritional Support: A Review of Current Literature

Abstract

Since the beginning of the practice of surgery, the reduction of postoperative complications and early recovery have been two of the fundamental pillars that have driven the improvement of surgical techniques and perioperative management. Despite great advances in these fields, the rationalization of antibiotic prophylaxis, and other important innovations, postoperative recovery (especially in elderly patients, oncological pathology or digestive or head and neck surgery) is tortuous. This can be explained by several reasons, among which, malnutrition has a major role. Perioperative nutritional support, included within the ERAS (Enhanced Recovery After Surgery) protocol, has proven to be a main element and a critical step to achieve better surgical results. Starting with the preoperative nutritional assessment and treatment in elective surgery, we can improve nutritional status using oral supplements and immunomodulatory formulas. If we add early nutritional support in the postoperative scenario, we are able to significantly reduce infectious complications, need for intensive care unit (ICU) and hospital stay, costs, and mortality. Throughout this review, we will review the latest developments and the available literature.

Preoperative Phase Angle as a Risk Indicator in Cardiac Surgery—A Prospective Observational Study

“…Although we found lower serum albumin levels in patients with lower preoperative PhA, the preoperative PhA was not influenced by the preoperative serum albumin levels in our cohort. Nevertheless, our observed serum albumin levels were higher than reported levels associated with cardiac cachexia or increased mortality, even in the cohort with low PhA [37].…”

Protein-energy malnutrition and worse outcomes after major cancer surgery: A nationwide analysis

“…Despite great advances in surgical techniques, postoperative recovery of cancer patients is tortuous, where malnutrition plays a major role ( 32 ). Our nationwide data analysis revealed that patients with PEM had a 2.26-fold risk of mortality compared to those without PEM after MCS, which was consistent with previous studies focusing on one specific cancer.…”

Effect of Sarcopenia on Survival and Health-Related Quality of Life in Patients with Hepatocellular Carcinoma after Hepatectomy

“…Compared with patients without sarcopenia, the short-term quality of life after laparoscopic surgery was significantly improved in those with sarcopenia. Nutritional status is one of the most recognized determinants of surgical outcomes and is associated with poor postoperative outcomes [ 45 ]. Approximately 40% to 50% of patients undergoing surgery have some degree of malnutrition [ 46 ].…”

“…As a treatment, HCC induces inflammatory responses and related neurohumoral regulation, leading to the upregulation of inflammatory cytokines such as interleukin (IL)-1, IL-2, and IL-6. Simultaneously, the levels of anti-inflammatory cytokines such as IL-4 and IL-10 are also increased to induce a stress response [ 45 ]. The activation of both the inflammatory and anti-inflammatory responses negatively impacts metabolism, bone density, muscle mass and strength, exercise tolerance, the circulation system, cognition, and emotion, all of which significantly increase surgical risk and worsen outcomes.…”

“…The activation of both the inflammatory and anti-inflammatory responses negatively impacts metabolism, bone density, muscle mass and strength, exercise tolerance, the circulation system, cognition, and emotion, all of which significantly increase surgical risk and worsen outcomes. Additionally, dietary restrictions and immobilization in surgical patients can also increase muscle loss and malnutrition [ 45 ]. Therefore, we recommend that clinicians should evaluate sarcopenia before surgery and carefully select appropriate surgical methods for the best outcome, especially in patients with sarcopenia.…”