Preoperative issues in clinical nutrition

Allowing a patient's nutritional state to deteriorate through the periopera tive period adversely affects measureable outcome related to nosocomial inf ection, multiple organ dysfunction, wound healing, and functional recovery. Careful preoperative nutritional assessment should include a determination of the level of stress, an evaluation of the status of the GI tract, and t he development of specific plans for securing enteral access. Patients alre ady demonstrating compromise of nutritional status (defined by > 10% weight loss and serum albumin level < 2.5 g/dL) should be considered for a minimu m of 7 to 10 days of nutritional repletion prior to surgery. Widespread use of total parenteral nutrition in unselected patients is unwarranted, may a ctually worsen outcome, and should be reserved for preoperative nutritional support only in severely malnourished patients in whom the GI tract is una vailable. Compared with die parenteral route, use of perioperative enteral feeding has been shown to provide more consistent and beneficial results, a nd can be expected to promote specific advantages in long-term morbidity an d mortality.