Is there a rationale for perioperative nutrition therapy in the times of ERAS?

Arved Weimann

doi:10.1515/iss-2019-0012

Abstract

In order to increase patient compliance in Enhanced Recovery after Surgery (ERAS) programs, assessment and monitoring of functional and nutritional status should be routinely performed. Sarcopenic obesity is frequently underestimated and has been shown to be a significant risk factor for the development of postoperative complications. With special regard to gastrointestinal cancer patients undergoing neoadjuvant treatment, nutritional deficiencies may develop stepwise and increase during therapy. In the case of proven deficits, recent strategies including “prehabilitation” focus on making the patient fit for an ERAS program. Evidence-based guidelines for perioperative nutrition therapy have been available.

Highlights

In the time of Enhanced Recovery after Surgery programs (ERAS), perioperative nutrition therapy seems to be very “traditional” and even redundant
From a metabolic and nutritional point of view, the European Society for Clinical Nutrition in Surgery (ESPEN) guidelines are in line with ERAS and include the following [4]: –– integration of nutrition into the overall management of the patient –– avoidance of long periods of preoperative fasting –– re-establishment of oral feeding as early as possible after surgery –– start of nutritional therapy early, as soon as a nutritional risk becomes apparent –– metabolic control e.g. of blood glucose –– reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function –– minimized time on paralytic agents for ventilator management in the postoperative period –– early mobilization to facilitate protein synthesis and muscle function
In a recent ERAS implementation study from Canada, nutritional risk measured by the Nutritional Risk Score (NRS) predicted low overall compliance (5 days; p = 0.052

Summary

Introduction

In the time of Enhanced Recovery after Surgery programs (ERAS), perioperative nutrition therapy seems to be very “traditional” and even redundant. Abstract: In order to increase patient compliance in Enhanced Recovery after Surgery (ERAS) programs, assessment and monitoring of functional and nutritional status should be routinely performed. With special regard to gastrointestinal cancer patients undergoing neoadjuvant treatment, nutritional deficiencies may develop stepwise and increase during therapy.

Results

Conclusion