Nutritional Support and the Surgical Patient

Yvonne Huckleberry

Disclosures

Am J Health Syst Pharm. 2004;61(7) 

In This Article

Protein

Protein serves an important role in tissue maintenance, wound healing, and slowing endogenous protein catabolism, particularly after major surgery. Postoperative protein requirements typically range between 1.2 and 2 g/kg, with the lower endappropriate for patients after uncomplicated elective surgery and the higher end recommended after major surgery.[37] Severe renal or hepatic dysfunction may require short-term protein restriction below this range, whereas large open wounds or burns can increase protein needs to >2 g/kg.

Among the few studies available that evaluated the influence of adequate NS protein and calories on postsurgical outcomes, a retrospective clinical-practice-improvement study by Neumayer et al.[69] involved eight hospitals and 1007 patients undergoing intestinal operations. The objective of the study was to evaluate the relationship between NS adequacy and the timing of its initiation in terms of length of stay and hospital costs. Sufficient NS was defined as at least 60% of the patient's calorie and protein goals. Early NS was defined as PN or EN initiated within 48 hours of surgery. Mean scores for disease and nutritional status were not significantly different between groups. After controlling for severity of illness, the authors found that early, sufficient NS significantly reduced length of stay and hospitalization fees compared with those patients fed early but not sufficiently or fed sufficiently but not early. Others have made similar conclusions in regard to EN,[70,71] suggesting that both the amount and timing of NS intervention are important factors in improving clinical outcomes.

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