New nutritional dogmata in surgical patients

New Nutritional Dogmata in Surgical Patients Severe malnutrition in surgical patients is associated with increased perioperative morbidity and mortality. In the past, nutritional support for these patients has focused mainly on the postoperative administration of nutrients. However, there is growing evidence that clinical outcome of severely malnourished patients can be improved by intensified preoperative nutritional support. Therefore, it is important to implement sufficient screening tests ( Subjective Global Assessment, SGA; Malnutrition Universal Screening Tool, MUST-Score) to identify those patients at risk of malnutrition who may benefit from adequate preoperative nutritional support. In addition, periods of prolonged preoperative starvation should be avoided in any patient, in order to ameliorate postoperative stress metabolism. Furthermore, traditional concepts of postoperative nutrition are changing. For example, the presence of a gastro-intestinal anastomosis used to be a contraindication for early enteral nutrition. It is now supposed that early postoperative enteral nutrition within 24-48 h after surgery using a catheter jejunostomy, a nasogastric or a nasojejunal tube is beneficial for most patients undergoing surgery of the gastro-intestinal tract. Only if a surgical patient is not able to meet his nutritional needs by enteral nutrition even after few days of adaptation or in the case of severe malnutrition, supplemental hypocaloric parenteral nutrition should be administered. Total parenteral nutrition should be reserved for patients with absolute contraindication for enteral nutrition ( mesenteric ischemia, prolonged ileus, prolonged severe diarrhea) or failure of the gastro-intestinal tract with inability to tolerate any amount of tube feeds. For improving clinical outcome, it is important to ensure continuation of adequate nutritional support from the initial postoperative period with the hormonal acute phase response to the time of rehabilitation when regular diet is well tolerated and the clinical signs of malnutrition are disappearing.