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Surgery is a heavy burden for the body. It can be said that its purpose is to deliberately injure the body for the overall benefit of the patient. But keep in mind that your body’s response to surgical trauma can shift your metabolism into catabolism – the process by which your body begins to take up and use proteins. If they are not supplied with food, the body will reach for them into the muscles.
The material was created in cooperation with Nutramil Complex.
The recovery process is designed to reverse trauma-induced catabolism towards anabolism. Proper nutrition, energy and protein supply are a key part of perioperative treatment.
Nutritional treatment definitely speeds up recovery. A significant number of patients can eat and should be allowed to do so. The goal of nutritional treatment should be to optimize fluid intake, ensure an adequate supply of energy and protein.
What is nutritional treatment?
Clinical nutrition treatment – is to improve and maintain adequate nutritional status. It also influences the prognosis and the effects of therapy.
Medical nutrition is based on composing the patient’s diet in such a way as to provide him with all the necessary building and energy nutrients (proteins, sugars, fats, minerals and vitamins). In nutritional treatment, ready-made industrial diets (eg Nutramil Complex) or intravenous fluids are used, the composition of which is determined on an ongoing basis depending on the current needs of the patient.
Nutrition before surgery
Currently, it is recommended that people on proper nutrition eat their usual meals until the night before surgery. Up to 2 – 3 hours before the anesthesia, you can take any amount of clean fluids, which helps to avoid preoperative dehydration.
It has also recently been shown that administering a carbohydrate-rich drink to a pre-operative patient quickly disappears from the stomach, and the addition of carbohydrates reduces preoperative hunger and anxiety. The supply of carbohydrates before surgery also reduces postoperative insulin resistance.
Preoperative nutrition is of particular importance in malnourished patients. It has been shown that in this group of patients, enteral and even parenteral nutrition applied 1-2 weeks before surgery significantly improves the results of surgical treatment.
Guidelines of the European Society of Anaesthesiology on perioperative fasting in adults and children
Oral carbohydrates:
- Consuming carbohydrate-rich drinks up to 2 hours before the planned surgery is safe for patients (also for diabetics),
- Drinking carbohydrate-rich fluids before elective surgery improves subjective well-being, reduces the feeling of hunger and reduces postoperative insulin resistance.
Nutrition after surgery
The most important thing for each patient is to return to normal functioning quickly after surgery in order to have as few complications as possible and to be discharged home quickly. To achieve this, it is necessary to minimize catabolism and allow the patient’s body to return to the state of anabolism. Nutrition plays a huge role in these processes. The liquid diet can be an important part of the nutritional treatment here. In more severe cases, enteral and parenteral nutrition also plays an important role.
Regardless of the method of nutrition recommended by the doctor (enteral through a tube or stoma, parenteral), it must be used until the patient is able to consume at least 70% of the energy and protein requirements through the oral route.
The amount of energy that the patient requires should be selected individually, but on average it ranges from 25 to 35 kcal / kg bw. After the procedure, the patient also needs more protein than a healthy person to rebuild damaged tissues and ensure the proper functioning of the immune system. The amount of protein a patient should consume is 1,2 to 1,5 g / kg bw, as long as the kidneys are working properly.
Wytyczne ESPEN — European Society for Clinical Nutrition and Metabolism
- Most patients do not need to fast before surgery at night. People without an increased risk of aspiration may drink fluids up to 2 hours before the start of anesthesia. Consumption of solid food is allowed up to 6 hours before the start of anesthesia.
- The preferred method of nutrition is through the gastrointestinal tract, except of course when it is contraindicated.
- Insufficient oral food intake for more than 14 days is associated with increased mortality. If the expected period of fasting in the perioperative period is longer than 7 days, enteral nutrition is recommended also in patients without signs of malnutrition.
- Enteral nutrition is also indicated in patients in whom the expected oral food supply will not exceed 10% of the demand for more than 60 days.
- Tube feeding should be started within 24 hours after the procedure, it is recommended in patients: after extensive operations due to cancer of the head, neck and gastrointestinal tract, after severe trauma, malnourished on the day of surgery, in whom the expected food supply will be <60% of the demand for more than 10 days.
- Standard diets containing complete protein are sufficient for most patients.
- The goal of perioperative treatment is to reduce negative nitrogen balance, prevent malnutrition, maintain muscle mass, maintain normal immunity, and speed up recovery after surgery.
- Patients who are properly nourished do not benefit from artificial nutrition, which may be a source of complications for them.
- Postoperative parenteral nutrition is recommended for patients who cannot meet their needs by oral or enteral route for 7-10 days after surgery. Combined parenteral-enteral nutrition should be considered here.
- Most often, it is recommended to supply 25 kcal / kg of ideal body weight. In patients under severe stress, the supply can be increased to 30 kcal / kg of ideal body weight.
- In patients who cannot be fed through the gastrointestinal tract, parenteral nutrition must be complete.
Nutrition before surgery improves the results of surgical treatment in severely malnourished patients, and preoperative carbohydrate administration reduces insulin resistance and protein catabolism after elective surgery. In addition, it has a positive effect on the patient’s well-being and reduces the stress associated with the planned procedure.
Most people undergoing surgery have no contraindications for a quick return to normal oral nutrition and should return to it as soon as possible. Postoperative gastrointestinal nutrition reduces the number of postoperative complications. Nutrition should be part of an integrated management throughout the patient’s treatment.
Bibliography:
1. Szczygieł B., Disease-related malnutrition, Warsaw 2012, PZWL, pp. 157-160
2. Sobotka L. et al., Fundamentals of clinical nutrition, Warsaw 2008, PZWL, pp. 296-300
The material was created in cooperation with Nutramil Complex.