Perioperative Nutrition Guidelines

Preoperative Nutrition

Patients should be screened for nutritional status prior to surgery; significantly malnourished patients should receive nutritional optimization with oral supplements or enteral nutrition before surgery 2, 3
Routine preoperative artificial nutrition is not warranted for well-nourished patients 2, 4
For bariatric surgery patients, a preoperative diet of 2-6 weeks may be beneficial to reduce liver volume and visceral adipose tissue 5
Traditional prolonged fasting should be avoided; clear fluids are permitted up to 2 hours before anesthesia and solids up to 6 hours before 6, 7
A carbohydrate-rich drink 2 hours before anesthesia reduces hunger, thirst, anxiety, and decreases postoperative insulin resistance 1, 7
Perioperative immunonutrition (containing arginine, glutamine, omega-3 fatty acids, and nucleotides) may reduce infectious complications and length of hospital stay 2, 8

Oral nutrition should be initiated within hours after surgery in most patients 1, 9
Early feeding does not impair healing of anastomoses and leads to significantly shortened length of hospital stay 1
Begin with clear liquids at room temperature for 24-48 hours post-surgery, gradually increasing volume to reach approximately 2L daily 5, 9
Progress to full liquids (milk, yogurt, soy drinks) within 3-7 days post-surgery 5
Advance to soft foods within 2 weeks and regular solid foods within 1 month post-surgery 5
For most non-bariatric surgeries, progression can be more rapid, with normal food often possible within 24 hours 1, 10
Aim for higher protein intake of 1.5 g/kg ideal body weight daily to support tissue repair and limit nitrogen losses 9
Target approximately 25-30 kcal/kg ideal body weight daily, with higher requirements during severe stress conditions 9
Ensure adequate micronutrient intake, particularly zinc, vitamin C, and vitamin D which are crucial for wound healing 11

Consider delaying elective surgery by 7-14 days in severely malnourished patients to allow for nutritional optimization 11
Provide oral nutritional supplements with high protein content to support recovery 9, 11
Consider combining nutritional support with resistance exercise to enhance recovery 9
Nutritional interventions should be part of a multidimensional approach involving a multidisciplinary team 9
Oral nutritional supplements are strongly recommended for geriatric patients after hip fracture and orthopedic surgery to reduce complications 9
Combine nutritional support with early mobilization to maximize recovery of muscle strength and function 9