18 Chirurgie und Transplantation

[Clinical nutrition in surgery. Guidelines of the German Society for Nutritional Medicine]

BACKGROUND

While enhanced recovery after surgery (ERAS) programs are the standard for perioperative management, special nutritional care has to be administered to malnourished patients and those at metabolic risk with special regard to patients with postoperative complications.

METHODS

Existing guidelines of the German and European societies of nutritional medicine (DGEM and ESPEN) on enteral and parenteral nutrition in surgery were merged and in accordance with the principles of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF, German Association of the Scientific Medical Societies) and Ärztliches Zentrum für Qualität in der Medizin (AeZQ, German Agency for Quality in Medicine) revised and extended.

RESULTS AND DISCUSSION

The working group developed 41 consensus-based recommendations for perioperative nutrition. The recommendation strength is: 9x A (recommendation based on significant good quality literature containing at least one randomized controlled trial), 12x B (recommendation based on well-designed trial without randomization), 13x C (recommendation based on expert opinions and/or clinical experience of respected authorities) and 7x CCP (clinical consensus point).

CONCLUSION

Even in patients without obvious malnutrition perioperative nutritional support is indicated when oral food intake is not feasible or inadequate for a longer period of time.

[Perioperative nutritional therapy]

BACKGROUND

There is no difference in medical and nutritional therapy between elderly and young surgical patients. However, based on the high prevalence of malnutrition or a risk for malnutrition and the associated risk for complications, elderly surgical patients should receive special attention.

AIM

This article addresses the options in perioperative nutritional therapy and gives an overview on current guidelines and study results.

MATERIALS AND METHODS

The article includes a literature review of current national and international guidelines in the field of surgery and geriatrics. Cochrane reviews, systematic reviews, meta-analyses, and significant single studies are also included.

RESULTS

Contrary to former approaches, national and international organizations recommend to keep the duration of pre- and postoperative fasting as short as possible. The benefits of nutritional therapy in stabilization and improvement of the nutritional status of surgical patients has already been shown in several patient groups like patients undergoing major abdominal surgeries. For other patients groups, like patients with sepsis, further studies are needed to evaluate the benefit of a perioperative nutritional intervention.