Descripción General Del Apoyo Nutricional Perioperatorio - UpToDate

4/11/21 12:30 Descripción general del apoyo nutricional perioperatorio - UpToDate
Autores: Kathleen S Romanowski, MD, FACS, Reza Askari, MD, FACS

Editores de sección: David Seres, MD, Amalia Cochran, MD, FACS, FCCM
Editor adjunto: Kathryn A. Collins, MD, PhD, FACS
Divulgaciones del colaborador
Todos los temas se actualizan a medida que se dispone de nueva evidencia y se completa nuestro proceso de revisión por pares .
Revisión de la literatura vigente hasta: octubre de 2021. | Este tema se actualizó por última vez: 13 de septiembre de 2021.
INTRODUCCIÓN
La desnutrición en pacientes hospitalizados está bien documentada, con tasas de hasta el 50 por ciento en ciertas poblaciones [ 1 ]. El apoyo
nutricional puede estar indicado para personas con desnutrición que requieren una intervención quirúrgica, o para personas sanas que se
someten a una cirugía mayor con un tiempo de recuperación prolongado anticipado para regresar a la función gastrointestinal normal. Sin
embargo, puede no estar claro cuándo es apropiado intervenir.
La noción de que la desnutrición puede afectar los resultados en pacientes quirúrgicos se informó por primera vez en 1936 en un estudio que
mostraba que los pacientes desnutridos sometidos a cirugía de úlceras tenían una tasa de mortalidad del 33 por ciento en comparación con el
3,5 por ciento en individuos bien nutridos [ 2 ]. En la década de 1990, un estudio prospectivo de 500 pacientes ingresados en un hospital
universitario en Inglaterra (incluidos 200 pacientes quirúrgicos) observó que el 40 por ciento estaban desnutridos al momento de la admisión [
3 ]. Además, los pacientes de este estudio perdieron un promedio del 5,4 por ciento de su peso corporal durante su estadía en el hospital.
Aquí se revisa una descripción general del apoyo nutricional en el período perioperatorio, incluidas las opciones y los beneficios potenciales.
La evaluación clínica y el seguimiento y el papel del apoyo nutricional parenteral en pacientes quirúrgicos, y los problemas de apoyo
nutricional en pacientes críticamente enfermos y otras poblaciones específicas se discuten por separado. (Consulte "Evaluación clínica y
seguimiento del apoyo nutricional en pacientes quirúrgicos adultos" y "Nutrición parenteral posoperatoria" y "Apoyo nutricional en pacientes
críticamente enfermos: descripción general" ).
https://bibvirtual.upch.edu.pe:2050/contents/overview-of-perioperative-nutrition-support?search=nutricion parenteral postoperatorio&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5 1/20
CONSECUENCIAS DE LA DESNUTRICIÓN EN PACIENTES QUIRÚRGICOS
Reduced caloric intake results in loss of fat, muscle, skin, and ultimately bone and viscera, with subsequent weight loss, and expansion of the
extracellular fluid compartment [4]. Nutritional requirements decrease as an individual's body mass decreases, reflecting more efficient
utilization of ingested food and a reduction in work capacity at the cellular level. However, the combination of decreased tissue mass and
reduced work capacity impedes normal homeostatic responses to stressors such as surgery or critical illness [5].
The stress of surgery or trauma creates a catabolic state, increasing protein and energy utilization. Macronutrients (fat, protein, and glycogen)
from the labile reserves of fat tissue and skeletal muscle are redistributed to more metabolically active tissues such as the liver and visceral
organs. This response can lead to the onset of protein calorie malnutrition (defined as a negative balance of 100 g of nitrogen and 10,000 kcal)
within a few days [6]. The rate of development of postoperative malnutrition for a given individual depends upon their preexisting nutritional
status, the nature and complexity of the surgical procedure, the degree of postoperative hypermetabolism, and their ability to consume an
optimal number of calories.
Malnutrition is associated with a number of negative consequences, including [4,5,7,8]:
● Increased susceptibility to infection

● Poor wound healing
● Increased frequency of decubitus ulcers
● Overgrowth of bacteria in the gastrointestinal tract
● Abnormal nutrient losses through the stool
Of particular concern for patients undergoing surgery are the risks of postoperative infection and poor wound healing. Malnutrition leads to
immune system dysfunction by impairing complement activation and production, bacterial opsonization, and the function of neutrophils,
macrophages, and lymphocytes [8]. One series reported that patients with malnutrition had subnormal skin reactions to Candida and low levels
of antibodies to various phytomitogens, suggesting that humoral and cell-mediated immunity are affected [9]. Patients with protein energy
malnutrition are also reported to have slower rates of wound healing, although most wounds will eventually heal on their own [10,11]. Additional
adverse effects associated with malnutrition were identified in a study of 2743 patients undergoing cardiothoracic surgery [12].

Patients with preoperative hypoalbuminemia alone or in association with chronic liver disease or heart failure were more likely to have
postoperative organ dysfunction (cardiac, pulmonary, renal, hepatic, neurologic), gastrointestinal bleeding, nosocomial infections, increased
days on mechanical ventilation and length of stay in the intensive care unit, and inpatient death [12]. A body mass index (BMI) <20 kg/m2 was
associated with lower morbidity and mortality compared with a higher BMI; however, this finding in this study contrasts with other studies. BMI
is an imperfect measure of nutritional status and should be used in conjunction with other clinical indicators.
NUTRITIONAL ASSESSMENT IN THE SURGICAL PATIENT
The first task when considering perioperative nutritional recommendations is to assess whether the patient has malnutrition.
The clinical assessment of the surgical patient includes a complete history and physical examination on admission, assessment of protein
status and may include other laboratory studies. These are discussed in detail separately. (See "Clinical assessment and monitoring of nutrition
support in adult surgical patients", section on 'History and physical'.)
Briefly, a nutritional assessment should include:
● Past medical history, noting chronic disease, infection, recent hospitalization, and prior surgery.
● Assessment of recent weight losses or gains and whether they were purposeful or not.
● Identification of current medications including nonprescription medicines and other supplements and any allergies or food intolerances
(See "Overview of herbal medicine and dietary supplements".)
● Dietary history
● A complete physical examination that includes vital signs, height and weight, and calculation of body mass index [BMI] ((calculator 1)(
figure 1).
● Signs of specific nutritional deficiencies ( table 1).

NUTRITIONAL INTERVENTIONS
Once it becomes clear that the patient will not be able to maintain adequate nutrition, nutritional intervention may include oral supplementation,
enteral (tube) feeding, or parenteral (intravenous) feeding. Enteral support is recommended over parenteral support because of its relative
simplicity, safety, reduced complications, and lower cost.
Enteral nutrition — Enteral nutrition support refers to the provision of calories, protein, electrolytes, vitamins, minerals, trace elements, and
fluids via an intestinal route, either orally or via a feeding tube.
● Oral supplementation – There is a wide variety of supplements available for oral supplementation in a wide range of styles (juice, yogurt,
milk shakes), formats (liquid, powder, pudding, pre-thickened), types (high protein, fiber-containing, low volume), energy densities (1 to
2.4 Kcal/mL), and flavors. Most oral supplements provide 300 Kcal, 12 g protein, and a full range of vitamins and minerals. Specific types
of oral supplements may benefit certain patients. In general, high-protein oral supplements are most suitable for patients with wounds and
those with malignancy. Prethickened supplements and puddings are helpful for providing nutrition support to individuals with dysphagia
and those with neurological conditions.
● Tube feeding – Enteral nutrition may be delivered in a gastric or postpyloric fashion. The available formulations, components, and delivery
of enteral nutrition are reviewed elsewhere. (See "Nutrition support in critically ill patients: An overview" and "Nutrition support in critically
ill patients: Enteral nutrition".)
Parenteral nutrition — Parenteral nutrition is an intravenous solution that contains dextrose, amino acids, electrolytes, vitamins, minerals, and
trace elements. The available formulations, components, and delivery of parenteral nutrition are reviewed elsewhere. (See "Postoperative
parenteral nutrition".)
INDICATIONS
The general indications for nutrition support include preexisting nutritional deprivation, anticipated or actual inadequate energy intake by mouth,
and significant multiorgan system disease. Among patients undergoing surgery, patients who undergo gastrointestinal surgery may be at a
greater nutritional disadvantage if the return of intestinal function is significantly delayed [13-19].
Early enteral feeding (oral, tube feeding) can be instituted following many types of surgery [19-21]. A Cochrane review and meta-analysis
updated in 2011 identified no obvious advantage to the routine practice of maintaining patients "nil per os" (ie, NPO) in the postoperative period
after gastrointestinal surgery [22]. (See 'Early enteral feeding' below.)
Some patients, such as those with inflammatory bowel disease, have an increased risk of having malnutrition when undergoing surgical
procedures. A period of bowel rest (nil per os) may be appropriate for patients with disease that is severe enough to require surgical
intervention. (See "Nutrition and dietary management for adults with inflammatory bowel disease".)
Parenteral support is indicated in postoperative patients who are unable to receive adequate enteral nutrition by postoperative days 10 to 14
[15,23]. Earlier enteral support may be appropriate in patients having malnutrition at baseline, or who have a complicated postoperative course
[24,25]. In patients undergoing bowel surgery for gastrointestinal malignancy, malignancy-related metabolic changes may also suggest the
need for earlier intervention. (See "Postoperative parenteral nutrition".)
OUTCOMES FOR NUTRITIONAL INTERVENTION
The majority of trials evaluating the potential benefits of perioperative nutrition support are small, and comparisons are difficult due to the wide
variety of operations studied, variability in methodology, and a lack of standard definitions and measures of malnutrition. The risks associated
with each route of nutrition support, plus the added cost, need to be taken into account, along with the potential benefits, when assessing the
need for perioperative nutrition support.
Preoperative nutrition support — For patients who are adequately nourished or who have mild-to-moderate malnutrition, surgery need not be
delayed for preoperative parenteral or enteral supplementation. Patients with severe malnutrition may derive some benefit from delaying
surgery to be fed, but the data on which these recommendations come from observational studies that are flawed [13,14,25]. Patients will
benefit more from enteral than parenteral feeding whenever it is possible; total parenteral nutrition increases risk for infectious complications.
Whether patients with severe malnutrition benefit or suffer harm from prolonged delay of surgery for preoperative nutrition support, particularly
when the malnutrition is due to the surgical disease, is unknown. However, if the malnutrition is largely the result of catabolic wasting, concerns
regarding significant delay of surgery include exposing the patient to further wasting and increasing surgical risk, since such wasting does not
respond to nourishment.
There is no question that surgical outcomes are less favorable in patients with malnutrition. A multicenter cohort study evaluated the effect of
preoperative nutrition support in 512 patients undergoing abdominal surgery who were at nutritional risk as defined by the Nutritional Risk
Screening Tool 2002 (NRS-2002) [25]. Of the 120 patients with an NRS score ≥5, the complication rate was significantly lower in the
preoperative nutrition group compared with the control group (25.6 versus 50.6 percent). The length of hospital stay was significantly shorter in
the preoperative nutrition group than in the control group (13.7 versus 17.9±11.3 days). No significant differences were seen for lesser NRS
scores.
Oral supplementation — A systematic review that focused on preoperative nutrition in patients undergoing gastrointestinal surgery included
three studies comparing preoperative liquid oral supplementation with usual care or dietary advice [26]. No significant differences were found in
the overall incidence of complications, infectious complications, or length of stay. Each of the trials evaluated a different oral supplement.
Parenteral nutrition — Most randomized trials of perioperative parenteral nutrition have been designed as "disease modifying," which is to
say that all patients with a particular condition were randomly assigned to receive parenteral nutrition or no artificial nutrition. As a result, much
of the data are not helpful to guide decisions related to the individual patient who cannot receive nourishment in any manner other than
parenterally. Several meta-analyses have evaluated preoperative parenteral nutrition but have reached inconsistent conclusions [27-29].
One systematic review found that preoperative parenteral nutrition (13 randomized trials) decreased postoperative complications by 10 percent,
while postoperative parenteral nutrition alone (8 randomized trials) resulted in a 10 percent increase in complication rates [29]. These findings
were not verified by a subsequent larger meta-analysis that included 41 trials of parenteral nutrition provided before and/or after surgery [28].
Parenteral nutrition had no effect on postoperative mortality, and there was no significant effect on postoperative complication rates, although
trends for all evaluated outcomes favored parenteral nutrition over no nutrition.
Another meta-analysis (26 randomized trials, although 3 were not in surgical patients) found a trend toward decreased complications in studies
where lipid-free solutions were used (relative risk [RR] 0.80, 95% CI 0.63-1.02), and for patients who had malnutrition (not consistently defined)
[27]. These findings were also not confirmed in the larger meta-analysis, which found greater benefit for total parenteral nutrition in trials where
lipids were used, and in trials evaluating well-nourished patients [28].

Studies have also focused on whether particular subgroups might benefit from preoperative parenteral feeding.
● An early study suggested that parenteral nutrition was beneficial in patients with upper gastrointestinal malignancies [30,31]. Mortality and
postoperative complications were decreased in a group of patients with gastrointestinal malignancies and weight loss (minimum 10
percent) who received 10 days of preoperative parenteral nutrition and 9 days of postoperative total parenteral nutrition, compared with
control patients who did not receive preoperative parenteral nutrition and were only partially supplemented postoperatively [32].
Preoperative treatment with parenteral nutrition also decreased morbidity in a group of patients undergoing resection for hepatocellular
cancer [33]. (See "The role of parenteral and enteral/oral nutritional support in patients with cancer".)
● The VA Cooperative study randomly assigned patients to parenteral nutrition for seven days preoperatively and three days
postoperatively or to control groups who either received no nutrition or were fed enterally [34]. Overall, patients who received parenteral
nutrition had a higher rate of infectious complications (14.1 versus 6.4 percent), but mortality rates were not significantly different (7.3 and
4.9 percent at 30 days). In a post hoc analysis of the subgroup with the most severe malnutrition, approximately 5 percent of the total
cohort, those treated with parenteral nutrition had fewer major postoperative complications than controls (20 to 25 percent versus 40 to 50
percent).
● In a later systematic review (discussed above) that focused on patients undergoing gastrointestinal surgery, preoperative parenteral
nutrition significantly reduced the risk for major complications (relative risk 0.64, 95% CI 0.46-0.87). However, no difference was observed
for infectious complications [26].
Postoperative nutrition support — For many postoperative patients, early oral or enteral nutrition (<24 hours) is possible and is associated
with beneficial effects. Enteral nutrition (oral or tube feeds) rather than parenteral nutrition should be instituted whenever possible. For patients
with a delayed return of intestinal function, postoperative parenteral nutrition is indicated only if return of bowel function is not anticipated for
more than 10 days. Earlier intervention may be appropriate in patients who have severe malnutrition at baseline, or who have a complicated
postoperative course. (See 'Indications' above.)
Early enteral feeding — Early postoperative enteral nutrition support may decrease the incidence of infectious complications but does not
impact other outcomes. Early nutrition is a component of most enhanced recovery after surgery (ERAS) protocols [35-37].

● A meta-analysis evaluated 44 randomized trials of perioperative enteral nutrition (predominantly postoperative support) [38]. Trials were
grouped into three comparisons: enteral nutrition versus no artificial nutrition, enteral nutrition versus parenteral nutrition, and volitional
nutritional supplements (oral supplemental feeding) versus no artificial nutrition. There were no mortality differences for any of the
comparator groups. Compared with no artificial nutrition, patients receiving enteral nutrition had fewer infections (absolute risk -11
percent, 95% CI -20 to -1 percent), but there was no significant impact on duration of hospitalization or the incidence of wound
complications. Patients who received postoperative oral nutritional supplements, compared with no supplements, also had a decreased
infection rate (absolute risk difference -10 percent, 95% CI -19 to -1), and a shorter length of hospital stay by two days (95% CI -3.37 to
-0.72).
● Another meta-analysis comparing enteral nutrition within 24 hours of gastrointestinal surgery with traditional postoperative management
showed a 45 percent decrease in the risk of overall postoperative complications in those patients receiving early postoperative feeding.
There were no differences in the incidence of anastomotic dehiscence, length of stay, or mortality [39].
● By comparison, a Cochrane review and meta-analysis updated in 2011 identified 14 trials that included 1224 patients undergoing
predominantly colorectal surgery [22]. No significant differences were identified in the risk of intra-abdominal abscess, anastomotic
leak/dehiscence, or pneumonia for patients started on early oral nutrition (initiated within 24 hours of surgery) compared with traditional
surgical care (ie, no nutrition or oral nutrition when tolerated). Length of hospital stay and the incidence of postoperative wound infection
were also similar. A meta-analysis of six of the trials found a slightly increased risk of vomiting (risk ratio 1.27, 95% CI 1.01-1.61). The
higher incidence of vomiting reported in the early feeding group did not appear to be related to oral intake compared with tube feeding. No
additional information was given regarding the type of surgery (open versus laparoscopic) or perioperative pain management (eg, opioid
or antiemetic use). A later systematic review and meta-analysis that focused on colorectal surgery found similar results; there was a
reduced length of hospital stay but no significant difference in the rate of vomiting between those who received early oral feeding
compared with those who did not [40].
Whether the route of enteral administration has any clinically important effect for surgeries other than colorectal surgery, which is the basis for
much of the literature on postoperative nutrition, is less certain. As an example, for pancreaticoduodenectomy, a systematic review of early
enteral nutrition did not show any differences in complication rates for five differing routes of administration, including an oral route; enteral
nutrition via either a nasojejunal tube, gastrostomy, or jejunostomy; or total parenteral nutrition (seven randomized trials, seven observational

studies) [41]. A later trial that randomly assigned 42 patients to a nasoenteric tube or jejunostomy tube following pancreaticoduodenectomy
also found no significant difference in complication rates [42]. However, the nasoenteral group required introduction of parenteral therapy
significantly more frequently than the jejunostomy group. In a trial comparing early nasojejunal tube feedings with early parenteral nutrition
support, the overall incidence of complications was higher for nasojejunal feedings (76 versus 64 percent) due to a higher incidence of
postoperative pancreatic fistula and delay in resumption of oral diet [43]. There were no significant differences in the incidence of infectious
complications or length of postoperative stay. (See "Surgical resection of lesions of the head of the pancreas", section on 'Nutrition support'.)
Total parenteral nutrition — Patients who are unable to tolerate enteral nutrition support will require intravenous fluid and total parenteral
nutrition at the discretion of the treating team until such time as they can be transitioned to enteral nutrition. (See "Postoperative parenteral
nutrition".)
Immune-enhancing nutritional supplements — The role for immune-enhancing nutritional supplements, also referred to as immunonutrition
(ie, enteral or parenteral supplementation with arginine, glutamine, nonessential fatty acids, branched chain fatty acids, nucleotides, or RNA),
remains unclear. There is insufficient high-quality evidence to suggest any specific supplementation for all surgical patients. (See 'Nutritional
interventions' above.)
Studies of individual and combinations of components of immunonutrition have demonstrated no effect on survival in surgical patients [44-60].
Several meta-analyses have evaluated immunonutrition [26,45-48,61-65]. Reductions in infectious complications and length of hospital stay
have been found, but without an effect on mortality. In a large review and meta-analysis of immunonutrition (including trials of glutamine,
arginine, omega-3 fatty acids, RNA, and nucleotides), there was no effect on perioperative mortality associated with major abdominal surgery.
Compared with control groups, immunonutrition reduced the risk of overall complications (odds ratio [OR] 0.79, 95% CI 0.66-0.94, 41 trials) and
infectious complications (OR 0.58, 95% CI 0.51-0.66, 66 trials), and shortened hospital stay (mean difference -1.79 days, 95% CI -2.39 to
-1.19, 52 trials) [48]. However, when excluding three trials judged by the authors to have a high or unclear risk of bias, these effects were no
longer seen. The authors of these meta-analyses have noted methodological flaws in the individual studies. It is worth noting that surgical
patients at the highest risk for postoperative complications have been excluded from the majority of studies on immunonutrition. A later
systematic review and metanalysis evaluated the utility of immunonutrition in surgical patients treated for cancer [61]. As demonstrated for
other populations, infectious complications were reduced, as was the risk for intestinal anastomotic complications; however, the rates of sepsis
and mortality were similar between the groups. Some of the limitations of this review include different types and stages of surgical cancers and

the lack of standard dosing or route of immunonutrition formula. Thus, until higher-quality data demonstrating unequivocal benefit are available,
immunonutrition cannot be recommended as a routine addition to nutritional supplementation in all surgical patients.
Probiotics/synbiotics — In addition to supplementation of calories or using immune-enhancing treatments, it has been speculated that
probiotics or synbiotics administered in the perioperative period may improve surgical outcomes. Probiotics are living microorganisms believed
to convey health benefits to the host. Synbiotics are nutritional supplementations combining probiotics with prebiotics, which are ingredients
(eg, fermentable fiber) that stimulate the growth and/or function of beneficial intestinal microorganisms. Probiotics or synbiotics can be
administered preoperatively, postoperatively, or both, and via oral or enteral routes.
Whether perioperative administration of probiotics/synbiotics improves outcomes of abdominal surgery is unclear. Routine use of
probiotics/synbiotics has not been uniformly adopted by the surgical community or within enhanced recovery protocols, but several systematic
reviews and meta-analyses have suggested a variety of possible benefits [66-70]. The latest of these was a systematic review that identified 34
trials in patients who predominantly underwent gastrointestinal or other abdominal (eg, pancreatic) surgeries [71]. Among 20 trials, patients
who received a variety of perioperative probiotics/synbiotics (n = 825) had a significantly lower risk of surgical site infection compared with
those who received valid control treatment (n = 424; relative risk [RR] 0.65; 95% CI 0.51-0.84). Among the included trials evaluating other
outcomes, probiotics/synbiotics were also associated with shortened time to first postoperative bowel movement, a reduced incidence of other
infectious complications such as pneumonia (RR 0.63, 95% CI 0.42-0.92) and urinary tract infection (RR 0.43, 95% CI 0.25-0.72), shortened
duration of antibiotic therapy, and shortened intensive care unit stay and hospital stay.
While these overall results appear promising, the trials were small, heterogeneous, and often at high risk of bias, and the long delay from the
last study analyzed until publication is a concern. Further study is needed to confirm these findings and determine the optimal agents (species,
strains), dosing (timing, route, duration), and clinical settings for use of probiotics or synbiotics. Because of episodes of fungemia in some
critically ill patients due to the organism supplemented, and worse outcomes in severe pancreatitis [72,73], the Society of Critical Care
Medicine and the American Society of Parenteral and Enteral Nutrition in guidelines for adult critically ill patients were unable to make a
generalized recommendation for their use [74].
SOCIETY GUIDELINE LINKS

Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. (See
"Society guideline links: Nutrition support (parenteral and enteral nutrition) in adults".)
SUMMARY AND RECOMMENDATIONS
● Malnutrition is a prevalent condition with important implications for patients undergoing surgery. When evaluating the patient for possible
intervention, the patient's nutritional status should be assessed by performing a history and physical examination. Judicious use of
laboratory tests aimed at assessing protein status is useful for determining prognosis but does not reflect protein intake. (See
'Consequences of malnutrition in surgical patients' above and 'Nutritional assessment in the surgical patient' above and "Dietary
assessment in adults".)
● Studies regarding outcomes of nutritional interventions in the perioperative period are numerous but are often of low quality, and
comparisons are difficult given the broad range of surgical settings and interventions. However, our general recommendations are as
follows (see 'Nutritional interventions' above and 'Outcomes for nutritional intervention' above):
• For patients who are not malnourished or who have mild-to-moderate malnutrition, surgery should not be delayed for preoperative
enteral or parenteral feeding.
• Patients with severe malnutrition may derive some benefit from delaying surgery for 10 to 14 days to be fed.
• Enteral nutrition is associated with fewer complications compared with parenteral nutrition. Patients benefit more from enteral feeding,
whenever possible, rather than total parenteral nutrition (TPN), as TPN is associated with an increased risk for infectious
complications.
• For many patients, early postoperative enteral nutrition (<24 hours) is possible and is associated with beneficial effects. Whenever
possible, enteral nutrition (oral or tube feeds) should be instituted, unless there is a specific contraindication.
• For patients with a delayed return of gut function, postoperative parenteral nutrition is not indicated unless bowel function is not
anticipated to return for more than 10 days. Earlier intervention may be appropriate in patients who are severely malnourished at

baseline, or who have a complicated postoperative course.
• The role for immunonutrition is unclear. Thus far, there is insufficient high-quality evidence to suggest any specific amino acid or other
supplementation for surgical patients.
ACKNOWLEDGMENT
The editorial staff at UpToDate would like to acknowledge Kathleen M Fairfield, MD, DrPH, who contributed to an earlier version of this topic
review.
Use of UpToDate is subject to the Subscription and License Agreement.
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4/11/21 12:30 Descripción general del apoyo nutricional perioperatorio - UpToDate

Autores: Kathleen S Romanowski, MD, FACS, Reza Askari, MD, FACS

Divulgaciones del colaborador

CONSECUENCIAS DE LA DESNUTRICIÓN EN PACIENTES QUIRÚRGICOS

Malnutrition is associated with a number of negative consequences, including [4,5,7,8]:

● Increased susceptibility to infection

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NUTRITIONAL ASSESSMENT IN THE SURGICAL PATIENT

Briefly, a nutritional assessment should include:

● Signs of specific nutritional deficiencies ( table 1).

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OUTCOMES FOR NUTRITIONAL INTERVENTION

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SOCIETY GUIDELINE LINKS

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SUMMARY AND RECOMMENDATIONS

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baseline, or who have a complicated postoperative course.

Use of UpToDate is subject to the Subscription and License Agreement.

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15. Souba WW. Nutritional support. N Engl J Med 1997; 336:41.

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74. Corrección. JPEN J Parenter Enteral Nutr 2016; 40: 1200.

Tema 2880 Versión 29.0

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