Promoting Perioperative Metabolic and Nutritional Care

  title={Promoting Perioperative Metabolic and Nutritional Care},
  author={Chelsia Gillis and Francesco Carli},
Surgery represents a major stressor that disrupts homeostasis and can lead to loss of body cell mass. Integrated, multidisciplinary medical strategies, including enhanced recovery programs and perioperative nutrition support, can mitigate the surgically induced metabolic response, promoting optimal patient recovery following major surgery. Clinical therapies should identify those who are poorly nourished before surgery and aim to attenuate catabolism while preserving the processes that promote… 

Perioperative Nutrition in the Orthopedic Surgical Patient

Registered dietitians should be consulted to assess and develop a nutrition care plan for patients whose compromised nutritional status may put them at risk for adverse outcomes after surgery.

Prehabilitation: metabolic considerations.

The metabolic implications of modulating preoperative risk factors with elements of multimodal prehabilitation, such as exercise training and nutrition are discussed.

Pre- and Post-Surgical Nutrition for Preservation of Muscle Mass, Strength, and Functionality Following Orthopedic Surgery

The goal of this review is to highlight oral nutrition strategies that can be implemented leading up to and following major surgery to minimize atrophy and the resultant loss of functionality.

ESPEN guideline: Clinical nutrition in surgery.

How Sweet Is This? A Review and Evaluation of Preoperative Carbohydrate Loading in the Enhanced Recovery After Surgery Model.

Barriers to the adoption of perioperative carbohydrate loading are few, but importantly include overcoming the inertia to modify older and more restrictive fasting guidelines and achieving the multidisciplinary consensus necessary to implement such changes.

Nutrition Status Optimization for Improved Perioperative Outcomes

It is advocated that no patient will ever undergo elective surgery without nutrition screening and optimization and nutritional interventions, including routine preoperative high protein oral nutrition supplements, immunonutrition, carbohydrate loading, and structured nutritional prehabilitation, should be standardized in all perioperative care pathways.

Nutrition Therapy in Sepsis.

Impact of Artificial Nutrition on Postoperative Complications

In patients with high risk for postoperative infections, perioperative immunonutrition has been proved in some ways to be effective, even if operations including those for cancer have to be delayed.

Post operative clinical nutrition

The focus of this guideline is to cover nutritional aspects of the Enhanced Re-covery 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.



Perioperative nutrition: what is the current landscape?

Adding immune/metabolic modulating formulas the week of surgery with carbohydrate drinks to optimize glycogen deposition immediately prior to surgery, enhances patient recovery and return to baseline function.

The Anabolic Effect of Perioperative Nutrition Depends on the Patient's Catabolic State Before Surgery

A significant association is demonstrated between the degree of preoperative catabolism, the patient's age, and the anabolic effect of hypocaloric nutrition in patients undergoing colorectal surgery.

The physiologic response and associated clinical benefits from provision of early enteral nutrition.

  • S. McClaveD. Heyland
  • Medicine
    Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
  • 2009
Use of alternative fuel sources, steps to promote better tolerance of EN, and innovative strategies for delivery of both EN and PN may serve to further enhance the physiologic effect of nutrition therapy and to achieve even greater improvement in patient outcome.

Metabolic Response to Severe Surgical Illness: Overview

  • D. Wilmore
  • Biology, Medicine
    World Journal of Surgery
  • 2000
Present evidence suggests that the central nervous system plays a major role in regulating this protein catabolic response, and demonstrates that the function of the hypothalamus and anterior pituitary is dampened during the later stages of severe surgical illness.

Epidural anaesthesia and analgesia - effects on surgical stress responses and implications for postoperative nutrition.

Epidural local anaesthetic blockade of afferent stimuli reduces endocrine metabolic responses, and improve postoperative catabolism, thereby providing optimal conditions for improved mobilization and oral nutrition, and preservation of body composition and muscle function.

Anticatabolic Effects of Avoiding Preoperative Fasting by Intravenous Hypocaloric Nutrition: A Randomized Clinical Trial

Hypocaloric nutrition decreases protein catabolism, with a contribution from the ubiquitin pathway in muscle, and stimulates albumin synthesis after colorectal surgery if initiated 1 day before the operation.

Patients requiring perioperative nutritional support.

Jonathan E. Rhoads lecture 2011: Insulin resistance and enhanced recovery after surgery.

  • O. Ljungqvist
  • Medicine
    JPEN. Journal of parenteral and enteral nutrition
  • 2012
This lecture reviews the current understanding of how insulin resistance, as a marker of the metabolic stress, is involved in recovery after major surgery and recommends several treatments, such as preoperative carbohydrate treatment instead of overnight fasting, continuous epidural anesthesia for postoperative pain care, early feeding, and mobilization.