Perioperative nutrition

Abstract

The incidence of malnutrition in hospitalized patients is high in our environment, and sometimes it worsens during the hospital stay (67%). In surgical patients who will be subjected to a surgical intervention and whose ingestion will be suppressed for digestive repose after the post-operative period, the situation becomes more complicated as in addition to their malnutrition there is an increased energetic-proteineic need due to the aggression. The direct relationship between severe malnutrition and an immune deficiency is translated into an increased morbidity (78%), into some extreme cases of mortality (24%), and always into longer hospitalizations. Implementing an adequate nutrition early will favorably influence the surgical results like any other therapeutic support measure. On the other hand, with the increased knowledge of the physiopathology of the gastrointestinal tract and its immunological function (GALT), the theoretical beneficial effect of intestinal repose has changed signs, with it being recommended to implement enteral nutrition rapidly post-operatively, with the physiological and practical advantages of enteral nutrition as opposed to parenteral nutrition being accepted unanimously. Immunomodulatory diets have shown their beneficial effect in specific situations: critical patients, septicemics, poly-traumatized patients, digestive tumor disease, etc., with infectious, scarring, and hospitalization complications decreasing significantly. When indicating peri-operative nutrition we must assess the disease and the characteristics hereof (benign, malignant, acute, or chronic), the surgical procedure used (aggression), the patient's prior nutritional status, the energetic needs (degree of aggression), the expected post-operative period, the expected fasting period (in function of the recommended intestinal repose and the expected complications), the available artificial nutrition routes (by patient limitations or strategic limitations of our environment), and finally, whenever possible, to use the enteral pathway.