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World Journal of Surgery

, Volume 17, Issue 2, pp 165–172 | Cite as

Underweight patients and the risks of major surgery

  • John A. Windsor
World Progress in Surgery—Metabolic Changes in Surgery

Abstract

The relation between weight loss and the risks of major surgery have been investigated for more than 50 years. It can now be said, with some confidence, that the underweight patient has an increased risk of complications following major surgery. This understanding, however, is based on methods of nutritional assessment that are of limited relevance to hospitalized patients whose malnutrition might be due to sepsis, neoplasia, trauma, or starvation. A consequence is the widespread belief that protein-energy malnutrition (PEM) has been overemphasized as a surgical risk factor, and that the many nonnutritional risk factors ought to be implicated more often. An argument is made for a fresh approach to nutritional assessment in order to better identify the individual patient who, by virtue of PEM, stands an increased risk of a complicated postoperative course. It is suggested that an evaluation of the impact PEM has on vital physiologic function provides a clinically relevant defect to identify and treat and a means of monitoring response to nutritional intervention.

Keywords

Physiologic Function Como Nutritional Intervention Nutritional Assessment Comme Facteur 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

Selon plusieurs études de ces 50 dernières années portant sur les rapports entre perte de poids et risques de la chirurgie majeure, on peut dire, avec une certaine confiance, que le risque de complications postopératoires est accru chez le patient dont le poids est au-dessous de la moyenne. Cependant, cette affirmation repose sur des méthodes d'évaluation nutritionnelle qui ont peu de rapport avec la situation le plus souvent rencontrée, qui concerne en fait les patients hospitalisés, dénutris du fait d'un sepsis, d'une néoplasie, d'un traumatisme grave, d'un état de sous-alimentation ou d'une combinaison de ces facteurs. La conséquence en est le sentiment répandu que la dénutrition protéique a été surestimée comme facteur de risque chirurgical et que d'autres facteurs, non nutritionnels, doivent être impliqués plus souvent. On avance des arguments nouveaux pour mieux identifier les patients à risque élevé de complications par leur seul état nutritionnel défaillant. On suggère que les conséquences de cet état de dénutrition sur la physiologie vitale sont cliniquement évidentes et sont suffisantes pour permettre d'identifier les patients à risque et de proposer des moyens pour surveiller les réponses à la correction des problèmes nutiritionnels.

Resumen

La relación entre la pérdida de peso y los riesgos de la cirugía mayor han sido motivo de investigación durante los últimos 50 anos. Actualmente se puede afirmar, con un cierto grado de seguridad, que el paciente con peso menor de lo normal tiene un riesgo aumentado de desarrollar complicaciones después de cirugía mayor. Sin embargo, tal aseveración se fundamenta en métodos de valoración nutricional que son apenas de limitada pertinencia en los pacientes hospitalizados cuya malnutrición puede ser debida a sepsis, neoplasia, trauma y/o ayuno. Una consecuencia de lo anterior es el sentimiento generalizado de que la desnutrición proteica-calórica (DPC) ha recibido énfasis excesivo como factor de riesgo quirúrgico, y de que numerosos factores de carácter no-nutricional deberían ser más comúnmente implicados. Se plantea una argumentación en pro de un enfoque fresco de la valoración nutricional con el objeto de identificar mejor aquellos casos individuales quienes, en virtud de DPC, se hallan en mayor riesgo de una evolución postoperatoria complicada. Se sugiere que una evaluación del impacto de la DPC sobre las funciones fisiológicas vitales provee la posibilidad de identificar y tratar una función fisiológica vital defectuosa y representa un medio de monitorizar la respuesta a la intervención nutricional.

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Copyright information

© Société Internationale de Chirurgie 1993

Authors and Affiliations

  • John A. Windsor
    • 1
  1. 1.University Department of SurgeryAuckland Public HospitalAucklandNew Zealand

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