Anaesthesia continues its preoperative optimization articles.
The frequent occurrence of malnutrition in pre-operative patients results in functional impairment, decreased immune defence, delayed wound healing and organ dysfunction. It increases infectious and non-infectious complications, length of stay, cost, readmission, and mortality. Muscle loss and fatty infiltration occur from disease, stress responses and treatment.
Evidence exists that correcting malnutrition can decrease complications and improve outcome. Assessing malnutrition may involve BMI, weight loss and dietary history and albumin measurement. Tools such as the Duke Peri‐operative Malnutrition Score, and Peri‐Operative Enhancement pathway are discussed. References are also provided to guidelines from the European Society for Clinical Nutrition and Metabolism, American Society of Parenteral Enteral Nutrition, and the American Society for Enhanced Recovery with Peri‐operative Quality Initiative.
Treatment involves protein supplementation and Vitamin D, omega-3 fatty acids, as well as immunonutrition with glutamine, arginine and cysteine. The authors advise a more equal distribution of protein through the day in synergy with exercise.