Perioperative Nutrition Support in Malnourished Surgical Patients

Abstract

Introduction: Malnutrition affects 30-50% of gastrointestinal surgery patients and increases complications. Optimal timing and route of nutrition support remain controversial. Methods: Systematic review of 11 RCTs (n=1,892) comparing preoperative immunonutrition (arginine, omega-3, nucleotides) versus standard oral supplements or no nutrition. Primary outcome: postoperative infectious complications. Secondary: hospital stay. Results: Immunonutrition reduced infectious complications (17.3% vs 28.9%, RR 0.60, p<0.001) and hospital stay (mean difference -3.1 days). Benefit was greatest when given ≥5 days preoperatively. No difference between enteral and parenteral routes in non-obstructed patients. Discussion: Immunonutrition modulates inflammatory response and preserves gut barrier function. Cost per infection prevented is approximately $1,200. Conclusion: Preoperative immunonutrition for at least 5 days is recommended for malnourished patients undergoing major gastrointestinal surgery.