Perioperative nutritional support for surgical patients

Pasechnik I.N.; Rybintsev V.Yu.; Markelov K.M.

doi:https://doi.org/10.17116/hirurgia202010195

Close metadata

Recommended articles:

Evaluation of perioperative correction of nutritional deficiency in patients with complicated forms of esophageal and gastric cancer. Pirogov Russian Journal of Surgery. 2025;(6):78-88

Resting energy expenditure assessment needs in patients with pancreatogenic sepsis. Russian Journal of Anesthesiology and Reanimatology. 2025;(3):26-33

Experience of inclusion of remaxol in rehabilitation therapy of patients after radical prostatectomy. P.A. Herzen Journal of Oncology. 2025;(4):54-60

Abstract:

The article presents an algorithm for perioperative nutritional support of surgical patients operated on as planned. Today, planned surgical care is provided in accordance with the canons of the accelerated rehabilitation Program (ARP). The relevance of the problem of nutritional insufficiency, which is an important component of ARP, is due to the dependence of the results of surgical treatment on the initial nutritional status of the patient. Methods of screening for nutritional deficiency and options for correcting protein-energy disorders are described. The predominant method is the enteral delivery of nutrients and energy. Oral supplemental nutrition by sipping is a convenient way to correct nutritional disorders at all stages of the perioperative period.

Keywords:

nutritional support

sipping

accelerated rehabilitation program

Authors:

Pasechnik I.N.

Central State Medical Academy RF President Affairs Department

ORCID: 0000-0002-8121-4160

Rybintsev V.Yu.

Central State Medical Academy of the President of the Russian Federation

Markelov K.M.

Central State Medical Academy of the President of the Russian Federation

Received:

16.07.2020

Accepted:

10.08.2020

Close metadata

References:

Zatevakhin II, Pasechnik IN. Programma uskorennogo vyzdorovleniia v khirurgii (fast trak) vnedrena. Chto dal’she? Vestn khirurgii im. I.I. Grekova. 2018;177(3):70-75. (In Russ.). https://doi.org/10.24884/0042-46252018-177-3-70-75
Felder S, Lechtenboehmer C, Bally M, Fehr R, Deiss M, Faessler L, Kutz A, Steiner D, Rast AC, Laukemann S, Kulkarni PM, Stanga Z, Haubitz S, Huber AR, Müller B, Schuetz P. Association of nutritional risk and adverse medical outcomes across different medical inpatient populations. Nutrition. 2015;31(11-12):1385-1393. https://doi.org/10.1016/j.nut.2015.06.007
Ben-Ishay O, Gertsenzon H, Mashiach T, Kluger Y, Chermesh I. Malnutrition in surgical wards: a plea for concern. Gastroenterol Res Pract. 2011;2011:840512. https://doi.org/10.1155/2011/840512.
Jie B, Jiang ZM, Nolan MT, Zhu S-N, Yu K, Kondrup J. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk. Nutrition. 2012;28:1022-1027. https://doi.org/10.1016/j.nut.2012.01.017
Gillis C, Wischmeyer PE. Pre-operative nutrition and elective surgical patient: why, how and what? Anaesthesia. 2019;74(suppl 1):27-35. https://doi.org/10.1111/anae.14506
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Ljungqvist O, Lobo DN, Martindale R, Waitzberg DL, Bischoff SC, Singer P. ESPEN: clinical nutrition in surgery. Clinical Nutrition. 2017;36:623-650.
Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser J-Cs. ESPEN guidelines on nutrition in cancer patients. Clinical Nutrition. 2017;36(1):11-48. https://doi.org/10.1016/j.clnu.2016.07.015
Wischmeyer P, Carli F, Evans D, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Grocott M, Gan T, Shaw AD, Thacker JKM, Miller TE, Hedrick TL, McEvoy MD, Mythen MG, Bergamaschi R, Gupta R, Holubar SD, Senagore AJ, Abola RE, Bennett-Guerrero E, Kent ML, Feldman LS, Fiore JF Jr; Perioperative Quality Initiative (POQI) 2 Workgroup. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia. Analgesia. 2018;126(6):1883-1895. https://doi.org/10.1213/ANE.0000000000002743
Reber E, Strahm R, Bally L, Schuetz P, Stanga Z. Efficacy and Efficiency of Nutritional Support Teams. J Clin Med. 2019;8(9):E1281. https://doi.org/10.3390/jcm8091281
Merker M, Gomes F, Stanga Z, Schuetz P. Evidence-based nutrition for the malnourished, hospitalised patient: one bite at a time. Swiss Med Wkly. 2019;149:w20112. https://doi.org/10.4414/smw.2019.20112
Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22:321-336.
Elia M. The «MUST» report. Nutritional screening of adults: a multidisciplinary responsibility. Redditch: BAPEN; 2003.
Williams DGA, Molinger J, Wischmeyer PE. The malnourished surgery patient: a silent epidemic in perioperative outcomes? Curr Opin Anaesthesiol. 2019;32(3):405-411. https://doi.org/10.1097/ACO.0000000000000722
Williams JD, Wischmeyer PE. Assessment of perioperative nutrition practices and attitudes — A national survey of colorectal and GI surgical oncology programs. Am J Surg. 2017;213:1010-1018.
Elia M, Stratton RJ. Calculating the cost of disease-related malnutrition in the UK in 2007. In Combating malnutrition: recommendations for action. A report from the Advisory Group on Malnutrition led by BAPEN. Redditch, Worcs.: BAPEN; 2009.
Stratton RJ, Elia M. Encouraging appropriate, evidence-based use of oral nutritional supplements. Proc Nutr Soc. 2010;69(4):477-487. https://doi.org/10.1017/S0029665110001977
Grass F, Bertrand PC, Schäfer M, Ballabeni P, Cerantola Y, Demartines N, Hübner M. Compliance with preoperative oral nutritional supplements in patients at nutritional risk — only a question of will? Eur J Clin Nutr. 2015;69(4):525-529. https://doi.org/10.1038/ejcn.2014.285
Zhong JX, Kang K, Shu XL. Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis. Asia Pac J Clin Nutr. 2015;24(3):367-378. https://doi.org/10.6133/apjcn.2015.24.3.20
Burden S, Todd C, Hill J, Lal S. Pre-operative nutrition support in patients undergoing gastrointestinal surgery. Cochrane Database of Systematic Reviews. 2012;11:Cd008879.
Scott A. Acting on screening results: a guide to treating malnutrition in the community. Br J Community Nurs. 2008;13:450-456.
Symons TB, Sheffield-Moore M, Wolfe RR, Paddon-Jones D. A moderate serving of high-quality protein maximally stimulates skeletal muscle protein synthesis in young and elderly subjects. J Am Diet Assoc. 2009;109:1582-1586.
Paddon-Jones D, Campbell WW, Jacques PF, Kritchevsky SB, Moore LL, Rodríguez N, van Loonet LJC. Protein and healthy aging. Am J Clin Nutr. 2015;101:1339-1345. https://doi.org/10.3945/AJCN.114.084061
Milne AC, Potter J, Vivanti A, Avenell A. Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev. 2009;15:CD003288.
Gianotti L, Braga M, Nespoli L, Radaelli G, Beneduce A, Di Carlo V. A randomized controlled trial of preoperative oral supplementation with a specialized diet in patients with gastrointestinal cancer. Gastroenterology. 2002;122:1763-1770.
Kabata P, Jastrzębski T, Kąkol M, Król K, Bobowicz M, Kosowska A, Jaśkiewicz J. Preoperative nutritional support in cancer patients with no clinical signs of malnutrition — prospective randomized controlled trial. Support Care Cancer. 2015;23(2):365-370. https://doi.org/10.1007/s00520-014-2363-4
Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35(2):370-380. https://doi.org/10.1016/j.clnu.2015.05.010
Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, Miyake M, Hama N, Miyamoto A, Ikeda M, Nakamori S, Sekimoto M, Kazumasa Fujitani K, Tsujinaka T. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol. 2015;22(suppl 3):778-785.
Maltby JR, Sutherland AD, Sale JP, Shaffer EA. Preoperative oral fluids: is five-hour fast justified prior to elective surgery? Anesth Analg. 1986;65:1112-1116.
Brady MC, Kinn S, Stuart P, Ness V. Preoperative fasting for adults to prevent perioperative complications (Review). Cochrane Database Syst Rev. 2003;4:CD004423. https://doi.org/10.1002/14651858.CD004423
Smith I, Kranke P, Murat I, Smith A, O’Sullivan G, Soreide E, Spies C, in’t Veld B; European Society of Anaesthesiology. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28(8):556-569.
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126:376-393.
Nygren J, Thorell A, Ljungqvist O. Preoperative oral carbohydrate therapy. Curr Opin Anaesthesiol. 2015;28:364-369.
Wang ZG, Wang Q, Wang WJ, Qin HL. Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery. Br J Surg. 2010;97:317-327.
Awad S, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of randomised controlled trials on preoperative oral carbohydrate treatment in elective surgery. Clin Nutr. 2013;32:34-44.
Smeshnoi IA, Pasechnik IN, Timashkov DA, Onegin MA, Cheparnov AV. Vliyaniye predoperatsionnoy peroralnoy uglevodnoy nagruzki na perioperatsionnyy period (pilotnoye issledovaniye). Consilium Medicum. 2019;21(8):88-92. (In Russ.). https://doi.org/10.26442/20751753.2019.8.190466
Pasechnik IN, Nazarenko AG, Gubaidullin RR, Gubajdullin RR, Lyadov KV, Procenko DN, Shelygin YuA, Shalvovich CM. Sovremennye podkhody k uskorennomu vosstanovleniiu posle khirurgicheskikh vmeshatel’stv. Doktor.ru. Anesteziologiia i reanimatologiia. Meditsinskaia reabilitatsiia. 2016;12(129):8-21. (In Russ.).
Barlow R, Price P, Reid TD, Hunt S, Clark GWB, Havard TJ, Puntis MCA, Lewis WG. Prospective multicentre randomised controlled trial of early enteral nutrition for patients undergoing major upper gastrointestinal surgical resection. Clin Nutr. 2011;30(5):560-566. https://doi.org/10.1016/j.clnu.2011.02.006
Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis. J Gastrointest Surg. 2009;13(3):569-575. https://doi.org/10.1007/s11605-008-0592-x
Zhang Y, Bao HG, Lv YL, Si YN, Han L, Wang H-Y, Gao Y-J, Jiang W-Q, Zhang C. Risk factors for early postoperative cognitive dysfunction after cmolorectal surgery. BMC Anesthesiol. 2019;19(1):6. https://doi.org/10.1186/s12871-018-0676-4
Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019;43(3):659-695. https://doi.org/10.1007/s00268-018-4844-y
Gillis C, Nguyen TH, Liberman AS, Carli FC. Nutrition Adequacy in Enhanced Recovery After Surgery: A Single Academic Center Experience. Nutrition in Clinical Practice. 2015;30:414-419.
Yeung SE, Hilkewich L, Gillis C, Heine JA, Fenton TR. Protein intakes are associated with reduced length of stay: a comparison between Enhanced Recovery After Surgery (ERAS) and conventional care after elective colorectal surgery. Am J Clin Nutr. 2017;106(1):44-51. https://doi.org/10.3945/ajcn.116.148619
Mortensen K, Nilsson M, Slim K, Schäfer M, Mariette C, Braga M, Carli F, Demartines N, Griffin SM, Lassen K, Enhanced Recovery After Surgery (ERAS®) Group. Consensus guidelines for enhanced recovery after gastrectomy Enhanced Recovery After Surgery (ERAS) Society recommendations. Br J Surg. 2014;101:1209-1229.
Yermilov I, Bentrem DJ, Jain S, Sekeris E, Hines OJ, Reber HA, Ko CY, Tomlinson JS. Utilization of Parenteral Nutrition Following Pancreaticoduodenectomy: Is Routine Jejunostomy Tube Placement Warranted? Dig Dis Sci. 2009;54:1582-1588.
Marimuthu K, Varadhan KK, Ljungqvist O, Lobo DN. A meta-analysis of the effect of combinations of immune modulating nutrients on outcome in patients undergoing major open gastrointestinal surgery. Ann Surg. 2012;255:1060-1068.
Wong CS, Aly EH. The effects of enteral immunonutrition in upper gastrointestinal surgery: A systematic review and meta-analysis. Int J Surg. 2016;29:137-150. https://doi.org/10.1016/j.ijsu.2016.03.043
Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet. 2002;359:1812-1818.