PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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(Article 116 | POJ_0110)

Submitted Abstracts

PENSA 2017 Congress

Submitted: October 4, 2017

Abstract ID = 80 | Classification: (2) - Malnutrition and related issues

Title: High risk surgical patients – Pre- and postoperative care

Author(s): Arved Weimann MD MA

Institution where study was conducted: KLinik für Allgemein-, Viszeral- und Onkologische Chirurgie, Klinikum St. Georg Leipzig, Germany

Keywords: malnutrition, surgery, prehabilitation, guidelines

Background: Preoperative functional dependency and/or impaired nutritional status define high risk surgical patients.

Objectives: For these patients the new “prehabilitation” concept including physical exercise, psychological support and nutrition therapy in an outpatient setting has proven functional improvement.


“Severe” nutritional risk has been defined for surgical patients according to the ESPEN working group as the presence of at least one of the following criteria:

  • Weight loss >10-15% within 6 months
  • BMI <18.5 kg/m2
  • SGA Grade C or NRS >5
  • Serum albumin < 30 g/L (with no evidence of hepatic or renal dysfunction)


The ESPEN guidelines 2017 state:

Patients with severe nutritional risk shall receive nutritional therapy prior to major surgery (A) even if operations including those for cancer have to be delayed (BM). A period of 7 to 14 days may be appropriate (0).

The key aspects of perioperative care include:

  • integration of nutrition into the overall management of the patient
  • avoidance of long periods of preoperative fasting
  • re-establishment of oral feeding as early as possible after surgery
  • start of nutritional therapy early, as soon as a nutritional risk becomes apparent
  • metabolic control e.g. of blood glucose
  • reduction of factors which exacerbate stress-related catabolism or impair GI function
  • minimized time on paralytic agents for ventilator management in the postoperative period
  • early mobilisation to facilitate protein synthesis and muscle function

Regular reassessment of nutritional status during the stay in hospital and, if necessary, continuation of nutritional support therapy including qualified dietary counselling after discharge, is advised for patients who have received nutritional support therapy perioperatively and still do not cover appropriately their energy requirements via the oral route.


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  • Carli F, Scheede-Bergdahl C.Prehabilitation to enhance perioperative care. Anesthesiology Clin 2015; 33: 17 – 33.
  • Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, Laviano A, Lobo DN, Ljungqvist O, Martindale R, Waitzberg D, Bischoff SC, Singer P. ESPEN Guideline Clinical Nutrition in Surgery, Clin Nutr 2017; 6: 623-650.