Impact of Perioperative Nutritional Support in Gastrointestinal Surgical Patients with Severe Malnutrition.

Abstract

Background: Severely malnourished patients undergoing major gastrointestinal surgery are at high risk of postoperative complications, increasing costs and length of hospital stay.

Objective: This study aimed to evaluate the impact of perioperative nutritional support on nutritional and surgical outcomes in these patients.

Methods: This was a prospective before-after study. Perioperative nutritional support in severely malnourished patients based on at least one of the following criteria: SGA.C, weight loss > 10% within 6 months, BMI < 18 kg/m2, serum albumin < 30 g/l. Once the patients were nourished achieving target energy continuously for at least 7 days and improved nutritional conditions, they were operated. Postoperative nutritional support lasted until hospital discharge. The preoperative and postoperative target energy intake was 30 and 25 kcal/kg, respectively. Enteral and parenteral feeding was combined perioperatively.

Results: A total of 53 patients underwent perioperative nutritional support combining one-stage surgery. Preoperative nutritional conditions improved. Postoperative catabolism was inevitable but patients early restored anabolism before hospital discharge. Overall and malnutrition-related postoperative complication rates were 11.3% and 7.5%, respectively, with no mortality or anastomotic leakage. The postoperative and perioperative average durations were 9 and 17.3 days, respectively. Nutritional and hospitalization costs were not high.

Conclusion: Perioperative nutritional support for severely malnourished patients undergoing major gastrointestinal surgery improved preoperative nutritional conditions, early restored anabolism postoperatively, provided positive surgical outcomes on postoperative complications, costs and length of hospitalization.