title: Nutrition optimization prior to surgery.
abstract: Optimization of metabolic state prior to major surgery leads to improved surgical outcomes. Nutrition screening protocols should be implemented in the preoperative evaluation, possibly as part of a bundle. Strategies to minimize hyperglycemia and insulin resistance by aggressive preoperative nutrition and carbohydrate loading may promote maintenance of a perioperative anabolic state, improving healing, reducing complications, and shortening the time to recovery of bowel function and hospital discharge. Short courses of preoperative immune-modulating formulas, using combinations of arginine, ω-3 fatty acids, and other nutrients, have been associated with improved surgical outcomes. These immune-modulating nutrients are key elements of metabolic pathways that promote attenuation of the metabolic response to stress and improve both wound healing and immune function. Patients with severe malnutrition and gastrointestinal dysfunction may benefit from preoperative parenteral nutrition. Continuation of feeding through the intraoperative period for severely stressed hypermetabolic patients undergoing nongastrointestinal surgery is another strategy to optimize metabolic state and reduce prolonged nutrition deficits. In this paper, we review the importance of preoperative nutrition and strategies for effective preoperative nutrition optimization.
authors.affiliation: Christopher M. Jones, University of Louisville, Hiram C. Polk Jr MD Department of Surgery, Ambulatory Care Building, 2nd Floor, Louisville, KY 40292, USA. Email: christopher.jones.1@louisville.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Evans
authors.forename: Robert G
authors.initials: RG
authors.lastname: Martindale
authors.forename: Laszlo N
authors.initials: LN
authors.lastname: Kiraly
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Jones
mesh_terms: D001120:Arginine / Q000008:administration & dosage; D015525:Fatty Acids, Omega-3 / Q000008:administration & dosage; D006801:Humans; D044342:Malnutrition / Q000175:diagnosis* / Q000517:prevention & control; D015201:Meta-Analysis as Topic; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
chemical_list: D015525:Fatty Acids, Omega-3; D001120:Arginine
keywords: enteral nutrition; nutrition assessment; nutritional support; parenteral nutrition; preoperative care; preoperative period; surgery