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Evaluation and Management of Malnutrition in the High-Risk Surgical Patient

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The High-risk Surgical Patient

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Abstract

Optimization of the nutritional requirements and prevention of malnutrition can have a positive effect on clinical outcomes in all surgical patients. Assessment of nutritional status and recognition of pre-existing malnutrition is the first tool of nutritional strategy. Medical history, clinical examination with anthropometric measurements, biochemical analyses, and a number of questionnaires are techniques for the determination of the nutritional status, but none of the parameters has been accepted as a gold standard. For the calculation of energy requirements, indirect calorimetry is the recommended method, but there are more than two hundred prediction equations that have been used. In general, 25 kcal/kg is considered an appropriate energy target for surgical patients. Oral nutrition is the best method of nutritional support. Intake of solid food is allowed until 6 h preoperatively, and the general attitude is that oral nutritional intake should continue without interruption post-surgery, adjusted to individual tolerance and type of surgical intervention. From a clinical point of view, nutritional therapy refers to enteral or parenteral nutrition. Perioperative nutritional therapy is indicated in patients who are undergoing major surgery patients with malnutrition and in patients with severe nutritional risk, or in those who are unable to take food perioperatively for more than 5 days or have an oral intake that cannot provide over 50% of the recommended intake longer than 7 days. In such cases, it is recommended to initiate enteral nutrition without delay. In situations when enteral nutrition is impossible or insufficient and energy requirements cannot be met within 7 days, parenteral nutrition has been proved to be sufficient.

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Authors and Affiliations

  1. University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Center, Medical Faculty, University “St. Cyril and Methodius”, Skopje, North Macedonia

    Biljana Andonovska & Alan Andonovski

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  1. Biljana Andonovska
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  2. Alan Andonovski
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Editors and Affiliations

  1. Dipartimento di Emergenza Urgenza, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Paolo Aseni

  2. Divisione di Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo, Pavia, Pavia, Italy

    Antonino Massimiliano Grande

  3. Div. of Emerg. Surg., Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland

    Ari Leppäniemi

  4. Department of Pathophysiology and Transplantation, General Surgery and Trauma Team, University of Milano, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy

    Osvaldo Chiara

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Andonovska, B., Andonovski, A. (2023). Evaluation and Management of Malnutrition in the High-Risk Surgical Patient. In: Aseni, P., Grande, A.M., Leppäniemi, A., Chiara, O. (eds) The High-risk Surgical Patient. Springer, Cham. https://doi.org/10.1007/978-3-031-17273-1_34

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  • DOI: https://doi.org/10.1007/978-3-031-17273-1_34

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  • Online ISBN: 978-3-031-17273-1

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