Malnutrition is common in surgical patients and is associated with substantially increased
morbidity and mortality. Dedicated assessment of nutritional status is advised by
major nutrition and surgical societies. Assessment may utilize comprehensive and validated
nutritional assessment tools or targeted history, physical examination with accompanying
serologic markers to identify nutritional risk preoperatively. Emergent surgery in
malnourished patients should proceed as the clinical situation dictates with consideration
of ostomy or primary anastomosis with proximal fecal diversion to mitigate postoperative
infectious complications. Nonemergent surgery should be delayed to facilitate nutritional
optimization via oral nutritional supplementation preferably and total parenteral
nutrition if necessary for at least 7 to 14 days. Exclusive enteral nutrition may
be considered to optimize nutritional status and inflammation in patients with Crohn's
disease. Immunonutrition use in the preoperative setting is not supported by evidence.
Perioperative and postoperative immunonutrition may be of benefit but requires dedicated
study in the contemporary era. Close attention to preoperative nutritional status
and optimization represents a critical opportunity to improve outcomes in patients
undergoing colorectal surgery.
Keywords
malnutrition - total parenteral nutrition - immunonutrition - prehabilitation
