Nutritional Support and the Surgical Patient

Yvonne Huckleberry

Disclosures

Am J Health Syst Pharm. 2004;61(7) 

In This Article

Discussion

Data showing that surgical patients clearly benefit from PN are lacking. The greatest advantage has been observed in severely malnourished patients, particularly when NS is initiated several days prior to surgery. Practice guidelines on perioperative NS have been summarized by A.S.P.E.N. and rated as A (guidelineis based on good, research-based evidence), B (guideline is supported by fair, research-based evidence), or C (guideline is based on expert opinion and consensus support).[96] The guidelines are as follows: (1) Moderately to severely malnourished patients scheduled for major GI surgery should receive 7 to 14 days of preoperative NS if surgery can be safely postponed (A rating), (2) PN should not routinely be prescribed in the immediate postoperative period for patients undergoing major GI surgery (A rating), and (3) postoperative NS is warranted if inadequate oral nutrition is anticipated for 7 to 10 days (B rating). These recommendations, while still current and useful, remind us that the role of NS needs to be defined for other surgical patient populations as well.

Nutrition-assessment tools, such as SGA and preoperative serum albumin, may be useful in identifying malnourished patients, and the timing of interventions can be planned accordingly. Early EN may offer advantages over PN, particularly if sufficient calories and protein can be provided. Immune-modulating formulas appear promising, but caution should be employed when the postoperative course deteriorates into critical illness. Well-designed, adequately powered, double-blind RCTs are warranted to better define the role of NS in improving postoperative clinical outcomes.

Conclusion

Surprisingly little evidence is available to support a significant impact of NS on postoperative clinical outcomes. More study is needed to define the role of NS in surgical patients.

CME Information

The print version of this article was originally certified for CME credit. For accreditation details, contact the educserv@ashp.org. American Society of Health-System Pharmacists, 7272 Wisconsin Avenue, Bethesda, MD 20814, 301-657-3000.

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