Perioperative malnutrition - NYSORA | NYSORA

Perioperative malnutrition

Learning objectives

  • Consequences of perioperative malnutrition
  • Recommendations to avoid perioperative malnutrition

Definition and mechanisms

  • Malnutrition in the perioperative period is associated with increased morbidity, mortality, length-of-stay, and healthcare costs
  • Is often a direct result of an underlying disease process
  • The importance of perioperative nutrition optimization continues to be poorly appreciated
  • The prevalence of preoperative malnutrition is up to 65% in patients undergoing surgery for cancer or gastrointestinal disease
  • However, perioperative malnutrition has proven to be challenging to define, diagnose, and treat
  • Patients are at risk of cancer cachexia, muscle protein depletion, poor wound healing, and systemic inflammation
  • Appropriate perioperative nutritional therapy improves perioperative outcomes in gastrointestinal/oncologic surgery specifically
  • Preventive, rather than ‘reactive’ boosting, of nutritional stores and general metabolic reserve can protect against the catabolic stress response of surgery
  • Nutritional optimization should start as early as feasible in the perioperative process
  • Enhanced recovery after surgery (ERAS) pathways recommend the use of clear fluid carbohydrate drinks in the immediate preoperative period to decrease the incidence of insulin resistance and postoperative hyperglycemia
  • Wishmeyer et al. 2018 on behalf of the American Society for Enhanced Recovery and Perioperative Quality Initiative 2 (POQI-2) pointed out the importance of nutritional screening and therapy within a surgically enhanced recovery pathway

Summary of current challenges and known benefits of perioperative nutrition interventions.

Summary of current challenges and known benefits of perioperative nutrition interventions. Figure adapted from Wischmeyer et al. 2018.

Perioperative Nutrition Screening Score (PONS)

  • To determine high-risk nutritional groups requiring referral to nutritionists for initiation or oral nutritional supplementation

Perioperative Nutrition Screening Score (PONS), BMI, weight loss score, albumin, nutrition


nutritional status, screening, PONS, BMI, albumin, CT scan, lean body mass, protein intake, oral nutritional supplement (ONS), enteral nutrition (EN), parenteral nutrition (PN), fasting, carbohydrate

High-protein diet, ONS, protein intake, enteral nutrition (EN), tube feeding, gastric residual volume, parenteral nutrition (PN)

Suggested reading

  • Matthews, L.S., Wootton, S.A., Davies, S.J., Levett, D.Z.H., 2021. Screening, assessment and management of perioperative malnutrition: a survey of UK practice. Perioperative Medicine 10.
  • Schonborn, J.L., Anderson, H., 2019. Perioperative medicine: a changing model of care. BJA Education 19, 27–33.
  • Williams, D.G.A., Molinger, J., Wischmeyer, P.E., 2019. The malnourished surgery patient. Current Opinion in Anaesthesiology 32, 405–411.
  • Wischmeyer, P.E., Carli, F., Evans, D.C., Guilbert, S., Kozar, R., Pryor, A., Thiele, R.H., Everett, S., Grocott, M., Gan, T.J., Shaw, A.D., Thacker, J.K.M., Miller, T.E., Hedrick, T.L., Mcevoy, M.D., Mythen, M.G., Bergamaschi, R., Gupta, R., Holubar, S.D., Senagore, A.J., Abola, R.E., Bennett-Guerrero, E., Kent, M.L., Feldman, L.S., Fiore, J.F., 2018. American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway. Anesthesia & Analgesia 126, 1883–1895.

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