Perioperative nutrition to enhance recovery after surgery

Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Patients at risk for malnutrition should be identified early. The Nutritional Risk Score is a validated tool to identify patients who should benefit from nutritional support. The adoption of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, has allowed clinicians to treat malnutrition and improve surgical patient’s outcomes. Periods of prolonged fasting should be minimized and nutrition should be commenced as early as possible after surgery, preferably through the enteral route. The surgical patient with established malnutrition should begin aggressive nutrition at least 7–10 days before surgery. Those patients in whom eating is not anticipated beyond the first 5 days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Many patients may benefit from newer enteral formulations, such as those designed to enhance immune function (immunonutrition).