PERIOPERATIVE NUTRITIONAL SUPPORT IN GASTROINTESTINAL SURGERY - WHY IS IT ESSENTIAL?

Abstract

Background: Malnutrition, sarcopenia, and obesity can negatively impact the course of gastrointestinal surgery, increasing the risk of postoperative complications such as anastomotic dehiscence, reoperations, increased mortality and morbidity, and prolonged hospitalizations, leading to higher healthcare costs. Weight loss greater than 10% in the previous six months is a prognostic indicator of mortality in gastrointestinal surgeries and one of the few modifiable variables. Preoperative malnutrition prevalence ranges from 17% to 20%, increasing the risk of infectious complications, especially in malignant diseases. Obesity, i.e., body mass index (BMI) ≥30.0 kg/m2, also impairs the clinical course, contributing to postoperative complications and hospital mortality. Enhanced recovery protocols, like ERAS, are becoming standard practice, with preoperative nutritional interventions crucial for improving surgical outcomes. However, there is no consensus on the ideal preoperative dietary intervention, but regardless of nutritional status, all individuals are eligible for preoperative screening. The American Gastroenterological Association (AGA) proposes to assess malnutrition using signs and symptoms, including unintentional weight loss, edema, loss of fat and body muscle mass, and fluid retention, in addition to BMI ≤18.5 kg/m2. In the case of malnutrition, the use of oral supplementation, enteral nutrition (EN), or parenteral nutrition (PN) is recommended, even if there is a need to postpone surgery. This article discusses the importance of nutritional status screening and perioperative nutritional support, emphasizing the need for a comprehensive approach to improve patients' quality of life and reduce postoperative complications.