3 Perioperative nutritional support

Abstract

A proportion of patients who undergo surgical operations display the clinical and metabolic characteristics of malnutrition, and these patients appear to be more likely to develop postoperative complications related to infection or poor healing than those who are normally nourished. Since the evolution of techniques which enable effective nutrition to be delivered during the perioperative period, even when the gastrointestinal tract is unavailable, many attempts have been made to test the hypothesis that perioperative nutritional support can reduce postoperative complications in the ‘malnourished’ patient. There is ample attestation to the beneficial influence of nutritional support upon postoperative complications based upon uncontrolled clinical experience, but verisimilitude is not proof. It appears possible to test the hypothesis relatively simply using the well established technique of the randomized clinical trial, but clear-cut answers have not emerged, probably because nutrition is often a minor component of the many determinants of operative outcome, and because precise and specific end-points by which to judge the efficacy of nutritional support are not available. Nevertheless, for both humanitarian and economic reasons, it is important to establish the role of perioperative nutritional support. THE CASE FOR PERIOPERATIVE NUTRITIONAL SUPPORT