Nutritional support and the surgical patient.
OBJECTIVE
Data on the impact of nutritional support (NS) on outcomes in surgical patients are reviewed.


CONCLUSIONS
While most patients will progress to oral nutrition after surgery and require little or no intervention, major surgery or postoperative complications can delay the prescription of an oral diet. In such patients, nutritional requirements are often increased to support wound healing and hypermetabolism associated with surgical recovery. Without adequate nutrition, muscle wasting, immune dysfunction, and declining visceral protein status are observed. While it would seem intuitive that early nutritional intervention is warranted for most patients, the literature to date suggests that early parenteral nutrition (PN) does not improve clinical outcomes. An exception may be for severely malnourished patients if NS is provided for at least seven days preoperatively. Such patients should be identified early through nutritional assessment. Early enteral nutrition (EN) may potentially improve patient outcomes compared with PN, but there are insufficient data to confirm this. High-dose parenteral glutamine may reduce infectious complications and the length of hospitalization for surgical patients, but a significant reduction in mortality has not been observed. Early EN with immune-enhancing formulas appears promising for general surgery patients. However, their use in the critically ill surgical patient is not unanimously supported, and some studies suggest potential harm.


CONCLUSIONS
Surprisingly little evidence is available to support a significant impact of early NS on postoperative clinical outcomes.
Huckleberry
Yvonne
Y
Department of Pharmacotherapy, College of Pharmacy, Washington State University, 257 Wegner Hall, P.O. Box 646710, Pullman, WA 99164-6710, USA. yhuck@wsu.edu
D004496:Education, Continuing; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control*; D018529:Nutritional Support; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome; D014481:United States; D014945:Wound Healing