ESPEN practical guideline: Clinical nutrition in surgery. Issue 7 (July 2021)

• Record Type: Journal Article
• Authors: Weimann, Arved; Braga, Marco; Carli, Franco; Higashiguchi, Takashi; Hübner, Martin; Klek, Stanislaw; Laviano, Alessandro; Ljungqvist, Olle; Lobo, Dileep N.; Martindale, Robert G.; Waitzberg, Dan; Bischoff, Stephan C.; Singer, Pierre
• Is Part Of: Clinical nutrition. Volume 40:Issue 7(2021)
• Page Start: 4745
• Page End: 4761
• Publication Date: 2021-07
• Subjects: Surgery -- Perioperative nutrition -- Nutritional therapy -- Bariatric surgery -- Organ transplantation -- ERAS -- Prehabilitation; BMI body mass index -- EN enteral nutrition -- ERAS Enhanced Recovery after Surgery -- LOS hospital length of stay -- NCJ needle catheter jejunostomy -- ONS oral nutritional supplements -- PEG percutaneous endoscopic gastrostomy -- PN parenteral nutrition -- RCT randomized controlled trial -- SOP standard operating procedure; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2021.03.031
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover both nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include the 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, the start of nutritional therapy immediately if a nutritional risk becomes apparent, metabolic control e.g. of blood glucose, reduction of factors which exacerbate stress-related catabolism or impaired gastrointestinal function, minimized time on paralytic agents for ventilator management in the postoperative period, and early mobilization to facilitate protein synthesis and muscle function.