Williams David G A, Wischmeyer Paul E
Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
Duke Clinical Research Institute, Durham, North Carolina.
Tech Orthop. 2020 Mar;35(1):15-18. doi: 10.1097/bto.0000000000000412. Epub 2019 Oct 4.
Despite evidence that malnutrition is associated with significant complications in orthopedic surgery, unrecognized malnutrition continues to be a "silent epidemic", effecting up to 50% of hospitalized patients. Specifically, pre-surgical malnutrition is associated with increased risk for surgical site infections, increased length of hospital stay, and increased health care costs in patients following total joint arthroplasty. Serologic markers (i.e. serum albumin and total lymphocyte count), anthropometric measurements, (i.e. calf muscle circumference and triceps skin fold) and assessment and screening tools (i.e. The Rainey-MacDonald Nutritional Index, the Mini Nutrition Assessment Short Form, the Malnutrition Universal Screening Tool and the Nutrition Risk Screening 2002) have all been used to aid in the diagnosis of malnutrition in orthopedic patients, yet there is no universal gold standard for screening or assessing nutritional risk and no accepted guideline for perioperative nutritional optimization in this patient population. Recently, the Perioperative Nutrition Screen (PONS) was introduced as an easy and efficient way to preoperatively identify and risk stratify patients for malnutrition in order to guide perioperative nutrition optimization. Given malnutrition is associated with increased risk of surgical site infections and increased length of hospital stay, adequate assessment of perioperative risk for malnutrition and preoperative nutrition optimization, including structured weight loss in the obese population, consumption of high protein oral nutritional supplements, immunonutrition oral supplements and adequate glucose control, may improve perioperative outcomes. The presence of a Registered Dietician (RD) should be a standard of care in all pre-operative clinics to improve nutrition care and surgical outcomes.
尽管有证据表明营养不良与骨科手术中的重大并发症相关，但未被识别的营养不良仍是一种“无声的流行病”，影响着高达50%的住院患者。具体而言，术前营养不良与手术部位感染风险增加、住院时间延长以及全关节置换术后患者的医疗费用增加有关。血清学标志物（如血清白蛋白和总淋巴细胞计数）、人体测量指标（如小腿肌肉周长和肱三头肌皮褶厚度）以及评估和筛查工具（如雷尼 - 麦克唐纳营养指数、简易营养评估简表、营养不良通用筛查工具和营养风险筛查2002）都已用于辅助诊断骨科患者的营养不良，但目前尚无用于筛查或评估营养风险的通用金标准，也没有针对该患者群体围手术期营养优化的公认指南。最近，围手术期营养筛查（PONS）被引入，作为一种简单有效的方法，用于术前识别营养不良患者并对其进行风险分层，以指导围手术期营养优化。鉴于营养不良与手术部位感染风险增加和住院时间延长相关，对围手术期营养不良风险进行充分评估以及术前营养优化，包括肥胖人群的结构化体重减轻、食用高蛋白口服营养补充剂、免疫营养口服补充剂以及适当的血糖控制，可能会改善围手术期结局。在所有术前诊所配备注册营养师（RD）应成为改善营养护理和手术结局的护理标准。
