Nutrition

Abstract

Nutrition assessment should be a routine part of any preoperative evaluation. Malnutrition is associated with increased rates of postoperative infection, impaired wound healing, and increased length of stay. The stress of surgery causes catecholamine and cortisol release, which results in a hypermetabolic state that can further exacerbate underlying malnutrition. Identifying patients with malnutrition and stratifying them according to severity of malnutrition allows for perioperative interventions that reduce surgical complications. In select cases, it may be beneficial to delay surgery for 5 to 7 days to optimize nutritional status to bolster the immune system and prepare the body for the systemic stress response to surgery. In the perioperative and postoperative period, both well–nourished and malnourished patients benefit from interventions focused on optimizing nutritional state, including immunonutrition and minimization of time spent nil per os (NPO). Additionally, the consulting internist should be aware of recommendations regarding initiation of nutrition postoperatively, with a focus on early advancement of diet or enteral feeding.