Heutlinger Olivia, Acharya Nischal, Tedesco Amanda, Ramesh Ashish, Smith Brian, Nguyen Ninh T, Wischmeyer Paul E
School of Medicine, University of California-Irvine, Irvine, California, United States.
School of Medicine, University of California-Irvine, Irvine, California, United States.
Adv Nutr. 2025 Jan;16(1):100351. doi: 10.1016/j.advnut.2024.100351. Epub 2024 Nov 29.
An increasing body of literature supports the clinical benefit of nutritional assessment and optimization in surgical patients; however, this data has yet to be consolidated in a practical fashion for use by surgeons. In this narrative review, we concisely aggregate emerging data to highlight the role of nutritional optimization as a promising, practical perioperative intervention to reduce complications and improve outcomes in surgical patients. This review of the surgical nutrition literature was conducted via large database review. There were no distinct inclusion/exclusion criteria for this review; however, we focused on adult populations using up-to-date literature from high-quality systematic reviews or randomized controlled trials when available. Current perioperative management focuses on the mitigation of intraoperative and immediate postoperative complications. Well-defined risk calculators attempt to stratify patient surgical risk preoperatively to reduce adverse events directly related to surgical procedures, such as hemorrhage, cardiopulmonary compromise, or infection. However, there is a lack of standardization of prognostic tools, nutritional protocols, and guidelines governing the assessment, composition, and administration of nutritional supplementation. Substantial data exist demonstrating the clinical benefit in the operative setting. In this work, we provide a fundamental primer for surgeons to understand the clinical importance of nutritional optimization along with practical prognostic tools and recommendations for use in their practice. While the extent to which nutritional optimization improves patient outcomes is debatable, the evidence clearly demonstrates a clinically meaningful benefit. Evaluating nutritional status differs based on disease severity and etiology of presentation, thus surgeons must select the appropriate prognostic tools to assess their patients during the perioperative period. This information will catalyze subsequent work with a multidisciplinary team to provide personalized dietary plans for patients and spark research to establish protocols for specific presentations.
越来越多的文献支持营养评估和优化对手术患者的临床益处；然而，这些数据尚未以实用的方式整合起来供外科医生使用。在这篇叙述性综述中，我们简要汇总了新出现的数据，以突出营养优化作为一种有前景的、实用的围手术期干预措施的作用，该措施可减少手术患者的并发症并改善其预后。本对外科营养文献的综述是通过大型数据库检索进行的。本综述没有明确的纳入/排除标准；然而，我们关注成年人群，如有高质量系统评价或随机对照试验的最新文献则优先使用。目前的围手术期管理侧重于减轻术中及术后即刻的并发症。明确的风险计算器试图在术前对患者的手术风险进行分层，以减少与手术操作直接相关的不良事件，如出血、心肺功能损害或感染。然而，在预后工具、营养方案以及营养补充剂的评估、组成和管理方面缺乏标准化。大量数据表明在手术环境中存在临床益处。在这项工作中，我们为外科医生提供了一个基本的入门知识，以了解营养优化的临床重要性，以及在实践中使用的实用预后工具和建议。虽然营养优化在多大程度上能改善患者预后仍有争议，但证据清楚地表明了其具有临床意义的益处。根据疾病严重程度和临床表现的病因不同，营养状况评估也有所不同，因此外科医生必须选择合适的预后工具来在围手术期评估患者。这些信息将促使后续与多学科团队合作，为患者提供个性化饮食计划，并激发相关研究以建立针对特定临床表现的方案。
