UNDERWEIGHT PATIENTS AND THE RISKS OF MAJOR SURGERY

The relation between weight loss and the risks of major surgery have b een investigated for more than 50 years. It can now be said, with some confidence, that the underweight patient has an increased risk of com plications following major surgery. This understanding, however, is ba sed on methods of nutritional assessment that are of limited relevance to hospitalized patients whose malnutrition might be due to sepsis, n eoplasia, trauma, or starvation. A consequence is the widespread belie f that protein-energy malnutrition (PEM) has been overemphasized as a surgical risk factor, and that the many nonnutritional risk factors ou ght to be implicated more often. An argument is made for a fresh appro ach to nutritional assessment in order to better identify the individu al patient who, by virtue of PEM, stands an increased risk of a compli cated postoperative course. It is suggested that an evaluation of the impact PEM has on vital physiologic function provides a clinically rel evant defect to identify and treat and a means of monitoring response to nutritional intervention.