Improving patient outcomes through perioperative nutrition support

Background

The primary aim in perioperative management is to reduce risks and optimize surgical outcomes for patients. Perioperative management should not only focus on operative techniques and postoperative care but include perioperative nutritional support, including adequate preoperative preparation. According to recent literature adequate perioperative nutrition leads to a decrease in complication rates, as well as decreased morbidity and mortality [1]. A recent Swiss-Austrian survey shows that nearly 80% of the senior leadership agreed, that attention to perioperative nutrition would decrease surgical complications. Only 20% of these leaders apply perioperative nutrition management. Reasons for not implementing nutritional screening and support were logistical and financial issues [2]. Therefore it was the aim of this project to standardize perioperative nutrition support at the University Hospital Graz and to facilitate perioperative nutrition management for all involved professions and to further improve patient outcomes.

Materials and methods

The interdisciplinary nutrition team of the University Hospital Graz, including dieticians, physicians, pharmacists and nurses developed a folder for perioperative nutrition management. This folder is based on the latest literature [3] and includes evidence based interventions for effective perioperative nutritional support.

Results

The folder "Perioperative Nutrition Support" includes recommendations for preoperative nutrition support, preoperative food/fluid intake and postoperative nutrition, especially for patients suffering from malnutrition. Pharmaconutrition should be applied in patients undergoing major elective surgery and patients with severe malnutrition [4]. To minimize postoperative complications carbohydrate loading should be applied to all patients undergoing elective surgery. Excluded are patients with diabetes or gastrointestinal stenosis [5]. Clear fluids, e.g. tea with/without sugar, coffee without milk or water, are allowed up to two hours before surgery. The folder also contains recommendations to early enteral feeding and oral nutrition after surgery [1].

Conclusions

To ensure patient safety as well as risk reduction in hospitalized patients undergoing surgery, perioperative nutrition support has to be part of perioperative management. Incorporation of latest nutrition research into daily practice is challenging. With implementation of the evidence based folder "Perioperative Nutrition Support" a standardized approach to improve patient outcomes with perioperative nutrition management can be achieved.