Wound healing response in surgical patients: Recent food intake is more important than nutritional status

Abstract

We have recently found that an impairment of the wound healing response (WHR) occurs in surgical patients with protein-energy malnutrition before there are any measurable changes in body fat and protein stores. The hypothesis of this study was that the patients' recent food intake is more important in determining the WHR than the patients' overall nutritional status. We have measured the recent food intake (by dietary recall), the WHR (by hydroxyproline accumulation in subcutaneous GORE-TEX implants), the pre-operative weight loss (per cent), and body fat and protein stores (by in vivo neutron activation analysis) in 83 patients awaiting a major elective gastrointestinal resection, and divided them into two groups: adequate recent food intake (n = 59) and inadequate recent food intake (n = 24). There was no significant difference between these two groups for age, sex, diagnosis, surgical procedure, weight loss (per cent), or the amount of body fat and protein stores but there was a significant difference in the WHR (1.81 +/- 0.16 s.e.m. versus 1.04 +/- 0.22 s.e.m. nmol hydroxyproline/mg GORE-TEX, P less than 0.005). These results show that pre-operative food intake has a greater influence over the wound healing response than absolute losses of protein and fat from body stores and they suggest that the maintenance of a normal food intake up until the time of surgery is of importance in preventing an impairment of the wound healing response.

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

“…21,22 Recent calorie intake may be more important than nutritional status. 23 Nutritional therapies alone in pre-operative situation are probably insufficient to treat active CD, 24 but, in association with antibiotherapy (and abscess drainage when appropriate), they seem to improve wound healing with a low rate of faecal diversion. In a prospective population-based study comparing hand-sewn and stapling anastomosis in patients with CD (where 98% of patients underwent ICR), the same preoperative management was reported before intestinal resection.…”

Metabolic basis for the management of patients undergoing major surgery

“…The physiotherapist may help by teaching the patient exercises that will be used postoperatively and how to turn in bed and move so pain is minimal. If investigations have gone on for several days and particularly if little food has been consumed over the previous week, the wound healing response will be impaired, and special care must be taken [17]. If there is any question of deficiency, vitamin C is given.…”

KIMS 14: a new scoring system to predict abdominal wound dehiscence following emergency laparotomy

“…Hypoalbuminemia is associated with poor wound healing, decreases collagen synthesis in the surgical wound and anastomosis. 16,17 it hampers the immune responses, such as macrophage activation and granuloma formation. Therefore, in hypoalbuminemic patients, wound infections, remote infections such as pneumonia, septicemia and anastomotic leakage are commonly found.it decelerates neoangiogenesis and wound remodeling.…”