title: ESPEN guideline: Clinical nutrition in surgery.
abstract: 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 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: • 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 • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.
authors.affiliation: Klinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg gGmbH, Delitzscher Straße 141, 04129 Leipzig, Germany. Electronic address: Arved.Weimann@sanktgeorg.de.
authors.forename: Arved
authors.initials: A
authors.lastname: Weimann
authors.affiliation: San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy. Electronic address: braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.affiliation: Department of Anesthesia of McGill University, School of Nutrition, Montreal General Hospital, Montreal, Canada. Electronic address: franco.carli@mcgill.ca.
authors.forename: Franco
authors.initials: F
authors.lastname: Carli
authors.affiliation: Department of Surgery & Palliative Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. Electronic address: t-gucci30219@herb.ocn.ne.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Higashiguchi
authors.affiliation: Service de chirurgie viscérale, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Electronic address: Martin.Hubner@chuv.ch.
authors.forename: Martin
authors.initials: M
authors.lastname: Hübner
authors.affiliation: General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050 Skawina, Krakau, Poland. Electronic address: klek@poczta.onet.pl.
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Klek
authors.affiliation: Dipartimento di Medicina Clinica, Universita "La Sapienza" Roma, UOD Coordinamento Attività Nutrizione Clinica, Viale dell'Università, 00185 Roma, Italy. Electronic address: alessandro.laviano@uniroma1.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laviano
authors.affiliation: Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. Electronic address: olle.ljungqvist@oru.se.
authors.forename: Olle
authors.initials: O
authors.lastname: Ljungqvist
authors.affiliation: Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK. Electronic address: dileep.lobo@nottingham.ac.uk.
authors.forename: Dileep N
authors.initials: DN
authors.lastname: Lobo
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., L223A, Portland, OR 97239, USA. Electronic address: martindr@ohsu.edu.
authors.forename: Robert
authors.initials: R
authors.lastname: Martindale
authors.affiliation: Department of Gastroenterology, School of Medicine, LIM-35, University of Sao Paulo, Ganep - Human Nutrition, Sao Paulo, Brazil. Electronic address: dan@ganep.com.br.
authors.forename: Dan L
authors.initials: DL
authors.lastname: Waitzberg
authors.affiliation: Institut für Ernährungsmedizin (180), Universität Hohenheim, 70593 Stuttgart, Germany. Electronic address: Bischoff.Stephan@uni-hohenheim.de.
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Bischoff
authors.affiliation: Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva 49100, Israel. Electronic address: psinger@clalit.org.il.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
mesh_terms: D013505:Digestive System Surgical Procedures; D005767:Gastrointestinal Diseases / Q000178:diet therapy* / Q000601:surgery*; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control; D015201:Meta-Analysis as Topic; D018673:Nutrition Policy; D009752:Nutritional Status; D018529:Nutritional Support; D064887:Observational Studies as Topic; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
keywords: ERAS; Enteral nutrition; Parenteral nutrition; Perioperative nutrition; Prehabilitation; Surgery