Zusammenfassung
Mit dem Ziel eines möglichst frühen oralen Kostaufbaus ist für Patienten mit großen chirurgischen Eingriffen die perioperative Behandlung in einem ERAS(„early recovery after surgery“)-Protokoll die Strategie der Wahl. So erscheint die perioperative (künstliche) Ernährungstherapie sehr traditionell. Dennoch darf auch in einer überernährten und adipösen Gesellschaft die Prävalenz einer kombinierten Mangelernährung und oder Sarkopenie nicht unterschätzt werden. Hieraus resultiert die Notwendigkeit der Erkennung eines metabolischen Risikos mit Indikation zur Ernährungstherapie. Der Artikel gibt eine Übersicht zu den aktuellen Konzepten der perioperativen Nahrungssupplementation und diskutiert die vorhandene Evidenz und Leitlinienempfehlungen.
Abstract
For patients undergoing major surgery, perioperative management according to an early recovery after surgery (ERAS) protocol focusing on early oral food intake is the strategy of choice. So-called perioperative nutritional (artificial) support now seems to be very traditional and outdated. Nevertheless, even in an overweight and obese society the prevalence of combined malnutrition and/or sarcopenia should not be underestimated. This results in the necessity for identification of patients at metabolic risk and the indications for nutritional therapy. This article provides a review of the current concepts of perioperative nutritional supplementation and discusses the available evidence and guideline recommendations.
Literatur
Adiamah A, Skorepa P, Weimann A, Lobo DN (2019) The impact of preoperative immune modulating nutrition on outcomes in patients undergoing durgery for gastrointestinal cancer: a systematic review and metaanalysis. Ann Surg 270:247–256
Agarwal E, Ferguson M, Banks M, Vivanti A, Batterham B, Bauer J, Capra S, Isenring E (2019) Malnutrition, poor food intake, and adverse healthcare outcomes in noncritically ill obese acute care hospital patients. Clin Nutr 38:759–766
Amer MA, Smith MD, Herbison GP, Plank LD, McCall JL (2017) Network meta-analysis of the effect of preoperative carbohydrate loading on recovery after elective surgery. Br J Surg 104:187–197. https://doi.org/10.1002/bjs.10408
Arends J, Weimann A (2020) Mangelernährung, Sarkopenie und Kachexie des Tumorpatienten. Onkologe (in Druck)
Baker M, Halliday V, Williams RN, Bowrey DJ (2016) A systematic review of the nutritional consequences of esophagectomy. Clin Nutr 35:987–994. https://doi.org/10.1016/j.clnu.2015.08.010
Berkelmans GHK, Fransen LFC, Dolmans-Zwartjes ACP, Kouwenhoven EA, van Det MJ, Nilsson M, Nieuwenhuijzen GAP, Luyer MDP (2020) Direct oral feeding following minimally invasive esophagectomy (NUTRIENT II trial): an international, multicenter, open-label randomized controlled trial. Ann Surg 271(31090563):41–47. https://doi.org/10.1097/SLA.0000000000003278
Caillet P, Liuu E, Raynaud SA, Bonnefoy M, Guerin O, Berrut G, Lesourd B, Jeandel C, Ferry M, Rolland Y (2017) Association between cachexia, chemotherapy and outcomes in older cancer patients: a systematic review. Clin Nutr 36:1473–1482
DIMDI – Komplexcode Ernährung – Ernährungsmedizinische Komplexbehandlung. www.dimdi.de – letzter Aufruf 18.11.20.
Elke G, Hartl WH, Kreymann KG, Adolph M, Felbinger TW, Graf T, de Heer G, Heller AR, Kampa U, Mayer K, Muhl E, Niemann B, Rümelin A, Steiner S, Stoppe C, Weimann A, Bischoff SC (2019) DGEM Leitlinie Klinische Ernährung in der Intensivmedizin.-Kurzversion. Anasthesiol Intensivmed Notfallmed Schmerzther 54:63–73
Elia M, Normand C, Norman K, Laviano A, Norman K (2016) A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr 35:370–380
Gillis C, Buhler K, Bresee L, Carli F, Gramlich , Culos-Reed N, Sajobi TT, Fenton TR (2018) Effects of nutritional prehabilitation with and without exercise, on outcomes of patients who undergo colorectal surgery: a systematic review and meta-analysis. Gastroenterology 155:391–410
Gillis C, Ferton T, Sajobi TT, Minnella EM, Awasthi R, Loiselle SE, Liberman AS, Stein B, Charlebois P, Carli F (2019) Trimodal prehabilitation for colorectal surgery attemuates post-surgical losses in lean body mass: a pooled analysis of randomized controlled trials. Clin Nutr 38:1053–1060
Gianotti L, Biffi R, Sandini M, Marrelli D, Vignali A, Caccialanza R, Vigano J, Sabbatini A, Di Mare G, Alesiani M, Antomarchio F, Valsecchi MG, Bernasconi DP (2018) Preoperative oral carbohydrate load versus placebo in major elective abdominal surgery (PROCY): a randomized placebo-controlled multicenter phase III trial. Ann Surg 267:623–630
Grass F, Bertrand PC, Schäfer M, Ballabeni P, Cerantola Y, Demartines N, Hübner M (2015) Compliance with preoperative oral nutritional supplements in patients at nutritional risk—only a question of will? Eur J Clin Nutr 69:525–529. https://doi.org/10.1038/ejcn.2014.285
Grass F, Benoit M, Coti BP, Sola J, Schäfer M, Demartines N, Hübner M (2016) Nutritional status deteriorates postoperatively despite preoperative nutritional support. Ann Nutr Metab 68:291–297. https://doi.org/10.1159/000447368
Gustafsson UO, Scott MJ, Hübner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadol TW, 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 (2019) Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery after Surgery (ERAS) Society Recommendations 2018. World J Surg 43:659–695
Hatao F, Chen KY, Wu JM, Wang MY, Aikou S, Onoyama H, Shimizu N, Fukatsu K, Seto Y, Lin MT (2017) Randomized controlled clinical trial assessing the effects of oral nutritional supplements in postoperative gastric cancer patients. Langenbecks Arch Surg 402:203–211. https://doi.org/10.1007/s00423-016-1527-8
Jang A, Jeong O (2019) Early postoperative oral feeding after total gastrectomy in gastric carcinoma patients: a retrospective before-after study using propensity score matching. JPEN J Parenter Enteral Nutr 43:649–657
Jensen GL, Cederholm T, Correia MTD, Gonzalez MC, Fukushima R, Higashiguchi T, Baptista G, Barrazoni R, Blaauw R, Coats A, Crivelli A, Evans DC Gramlich L, Fuchs-Tarlovsky V, Keller H, Lido L, Malone A, Morgensen KM, Morley JE, Muscaritoli M, Nyulasi I, Pirlich M, Pisprasaert V, de van der Schueren MAE, Siltharm S, Singer P, Tappenden K, Velasco N, Waitzberg D, Yamwong P, Yu J, Compher C Van Gossum A (2019) GLIM Core Leadership Committee; GLIM Working Group. GLIM criteria for the diagnosis of malnutrition . a consensus report from the global clinical nutrition community. JPEN J Parenter Enteral Nutr 43: 32–40
Kondrup J, Allison SP, Elia M, Vellas B, Plauth M, Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN) (2003) ESPEN guidelines for nutrition screening 2002. Clin Nutr 22:415–421
Lidoriki I, Schizas D, Mylonas KS, Frountzas M, Mastoraki A, Pikoulis E, Liakakos T, Karavokyros I (2020) Oral nutritional supplementation following upper gastrointestinal cancer surgery: A prospective analysis exploring potential barriers to compliance. J Am Coll Nutr 39:650–656. https://doi.org/10.1080/07315724.2020.1723453
Martin L, Gillis C, Atkins M, Gillam M, Sheppard C, Buhler S, Hammond CB, Nelson G, Gramlich L (2019) Implementation of an Enhanced Recovery After Surgery Program can change nutrition care practice: a multicenter experience in elective colorectal surgery. JPEN J Parenter Enteral Nutr 43:206–219
Meng Q, Tan S, Jiang Y, Han J, Xi Q, Zhuang Q, Wu G (2020) Post-discharge oral nutritional supplements with dietary advice in patients at nutritional risk after surgery for gastric cancer: a randomized clinical trial. Clin Nutr. https://doi.org/10.1016/j.clnu.2020.04.043
Moya P, Soriano-Irigiaray L, Ramirez JM, Garcea A, Blasco O, Blanco F, Brugiotti C, Miranda E, Arroyo A (2016) Perioperative standard oral nutrition supplements versus immunonutrition in patients undergoing colorectal resection in an enhanced recovery (ERAS) protocol: a multicenter randomized Clinical Trial (SONVI Study). Medicine 95(21):e3704
Olotu C, Weimann A, Bahrs C, Schwenk W, Scherer M, Kiefmann R (2019) The perioperative care of older patients. Dtsch Arztebl Int 116:63–69
Pradelli L, Mayer K, Klek S, Alsaleh OAJ, Clark RAC, Rosenthal MD, Heller AR, Muscaritoli M (2020) ω‑3 fatty-acid enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis and trial sequential analysis. JPEN J Parenter Enteral Nutr 44:44–57
Ridley EJ, Parke RL, Davies AR, Bailey M, Hodgson C, Deane AM, McGuinness S, Cooper DJ (2019) What happens to nutrition intake in the post-intensive care unit hospitalization period? An observational cohort study in critically ill adults. JPEN J Parenter Enteral Nutr 43:88–95
Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Tribolet F, Bregenzer T, Braun N, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Hezen C, Maltmann S, Thomann R, Brand C, Rutishauiser J, Aujesky D, Rodondi N, Donzé J, Stanga B, Mueller B (2019) Individualized nutritional support in medical inpatients at nutritional risk: a randomized clinical trial. Lancet 393:2312–2321
Schwenk W (2021) Bessere Genesung nach Operationen – hält ERAS, was es verspricht? Chirurg (im Druck)
Simonsen C, de Heer P, Bjerre ED, Suetta C, Hojman P, Pedersen BK, Svendsen LB, Christensen JF (2018) Sarcopenia and postoperative complication risk in gastrointestinal surgical oncology: a meta-analysis. Ann Surg 268:58–69
Troesch B, Eggersdorfer M, Laviano A, Rolland Y, Smith AD, Warnke I, Weimann A, Calder PC (2020) Expert opinion on benefits of long-chain omega‑3 fatty acids (DHA and EPA) in aging and clinical nutrition. Nutrients 12:255. https://doi.org/10.3390/nu120925555
Weimann A, Breitenstein S, Breuer JP, Gabor SE, Holland-Cunz S, Kemen M, Längle F, Rayes N, Reith B, Rittler P, Schwenk W, Senkal M und das DGEM Steering Committee (2014) Klinische Ernährung in der Chirurgie, S3 Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin e. V. (DGEM) in Zusammenarbeit mit der Gesellschaft für klinische Ernährung der Schweiz (GESKES), der Österreichischen Arbeitsgemeinschaft für klinische Ernährung (AKE), der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), der Deutschen Gesellschaft für Anästhesie, Intensiv- und Notfallmedizin (DGAI) und der Deutschen Gesellschaft für Chirurgie (DGCH), Chirurg 85; 320–326
Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Lobo DN, Ljungqvist O, Martindale R, Waitzberg D, Bischoff SC, Singer P (2017) ESPEN guideline clinical nutrition in surgery. Clin Nutr 36:623–650
Williams DGA, Molinger J, Wischmeyer PE (2019) The malnourished surgery patient: a silent epidemic in perioperative outcome. Curr Opin Anaesthesiol 32:405–411
Wischmeyer PW, Carli F, Evans DC, Guilbert S, Kozar R, Pryor A, Thiele RH, Everett S, Rocott M, Gan TJ, Shaw AD, Thacker KM, Miller TE, Perioperative Quality Initiative (POQI) 2 Workgroup (2018) American Society for Enhanced Recovery and Perioperative Quality Initiative joint consensus statement on nutritional screening and therapy within a surgical enhanced recovery pathway. Anesth Analg 126:1883–1895
Wobith M, Alsakka K, Grosser K, Weimann A (2019) Einfluss der präoperativen, kognitiven Funktion auf die Komplikationsrate und die Krankenhausverweildauer bei hochbetagten Patienten. Chirurg 90:930–935
Wobith M, Wehle L. Haberzettl D, Acikgöz A, Weimann A (2020) Needle catheter jejunostomy in patients undergoing surgery for upper gastrointestinal and pancreato-biliary cancer—impact on nutritional and clinical outcome in the early and late postoperative period. Nutrients 12: 2564: doi10.339/nu12092564
Wobith M, Gockel I, Weimann A (2020) Ernährung zur Konditionierung vor Tumoroperationen. Prähabilitation Onkol Epub Ahead Print. https://doi.org/10.1007/s00761-020-00855-x
Zhang B, Najarali Z, Ruo L, Alhusaini A, Solis N, Valencia M, Sanchez MIP, Serrano PE (2019) Effect of perioperative nutritional supplementation on postoperative complications-systematic review and meta-analysis. J Gastrointest Surg 23:1682–1693. https://doi.org/10.1007/s11605-019-04173-5
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
A. Weimann gibt Vortragshonorare von Baxter, B. Braun/Melsungen, Ethicon, Falk Foundation, Fresenius Kabi sowie Forschungsunterstützung von Baxter und Mucos an.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Additional information
Redaktion
U. Settmacher, Jena
Rights and permissions
About this article
Cite this article
Weimann, A. Perioperative Nahrungssupplementation – Was ist wirklich evidenzbasiert?. Chirurg 92, 397–404 (2021). https://doi.org/10.1007/s00104-020-01329-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00104-020-01329-x