Nutritional support in reoperative surgical patients

The reoperative surgical patient faces many challenges in the preoperative, operative, and postoperative periods. Reoperative patients may include those undergoing staged surgeries or damage control in the hyperacute setting, patients who need additional surgery for a complication such as anastomotic leak, or those who require later surgery for conditions such as enterocutaneous fistula or wound closure.

A literature search was conducted in PubMed to identify the impact of preoperative, perioperative, and postoperative nutrition on outcomes of reoperative surgical patients.

Perioperative nutritional screening is recommended but underutilized. Screening can involve scoring systems, anthropometric measurements, and frailty screening, in conjunction with some biochemical tests. If the patient is deemed to be malnourished, a tailored approach to prehabilitation nutrition and supplementation should be followed. The reoperative surgical patient has likely not had the opportunity for prehabilitation and remains at risk for worsening malnutrition during their subsequent course. Malnutrition has been linked to impaired healing, increased infections, longer hospitalizations, higher costs, and higher mortality.

Correction of malnutrition through an individualized approach including enteral and parenteral nutrition as well as protein, carbohydrate, micronutrient, and immunonutrition goals is necessary. The volume status of reoperative patients is important, as it affects screening studies and organ function and should be closely monitored. Special attention should be given to obese patients, those on extracorporeal membrane oxygenation or continuous renal replacement therapy, and patients with short bowel syndrome and fistulae. Further research is necessary to assist in the individualization of preoperative, perioperative, and postoperative nutritional therapies for these complex at-risk patients.