Preoperative Nutritional Conditioning: Why, When and How

Abstract

<b><i>Background:</i></b> Malnutrition is a frequent finding in patients undergoing cancer surgery, especially in the elderly. The decreased nutritional status leads to increased complications and to delayed recovery after the surgical procedure. While established concepts of enhanced recovery after surgery and rehabilitation aim at improving the patient <i>after</i> surgery, the concept of prehabilitation is targeting the phase <i>before</i> surgery. This multimodal concept incorporates preoperative nutritional support. <b><i>Summary:</i></b> Nutritional conditioning targets an increase in the functional reserve preoperatively to optimize recovery in the postoperative period. Routinely, it is combined with an exercise program according to the patient’s state. Individualized meal plans help to meet the patient’s requirements and should start approximately 4 weeks prior to surgery. An important part of the nutritional conditioning is to guarantee a daily protein intake of at least 1.2 g/kg body weight. This may be realized by commercially available whey proteins in particular or milk proteins in general. <b><i>Key Messages:</i></b> All specialists involved in the care of cancer patients should recognize the care continuum that starts when the need for surgery is identified and aims at increasing the functional capacity throughout the pre-, peri- and postoperative phase by means of prehabilitation, enhanced recovery programs and rehabilitation.

Optimisation of the high-risk thoracic surgical patient: a narrative review

“…The duration of optimisation is once again controversial. While the ERAS guidelines suggest 5-7 days of preoperative nutrition in those that are deplete (along with the routine use of preoperative oral carbohydrate drinks) (10), prehabilitation studies in other surgical specialties use at least four-week protocols (47,48). In contrast to the ERAS guidelines, the ESPEN guidelines recommend 7-14 days of preoperative nutrition in patients who are undernourished (49).…”

Prehabilitation in Patients before Major Surgery: A Review Article

“…Though carbohydrate loading one day before surgery was also found to be unproductive with regard to the duration of hospital stay and postsurgical lethargy, it does halve insulin resistance in the postoperative phase. 35 The exercise and nutrition programs commenced between 2 and 12 weeks preoperatively have shown to increase the overall benefits. In the case of high-risk individuals with severe malnutrition, enteral nutrition should be exclusively favoured if more than 60% of the energy demand can be fulfilled.…”

Preoperative optimization of geriatric and frail patients

“…Malnutrition in the geriatric population is associated with various complications, ranging from surgical site infections due to a weakened immune system, postoperative cognitive dysfunction, poor wound healing, increased length of hospital stay, to death. 93,94 After consulting with a registered dietician nutritionist, a patient can receive a tailored meal plan and weight monitoring. Education on nutritional health can help the patient to take steps on preparing meals with nutrient-rich food, consuming proper dietary supplements, planning healthy snacks between meals, and finding the preferred food flavor to improve appetite.…”