ESPEN guideline

Clinical nutrition in surgery

Arved Weimann, Marco Braga, Franco Carli, Takashi Higashiguchi, Martin Hübner, Stanislaw Klek, Alessandro Laviano, Olle Ljungqvist, Dileep N. Lobo, Robert Martindale, Dan L. Waitzberg, Stephan C. Bischoff, Pierre Singer

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.

Original languageEnglish
Pages (from-to)623-650
Number of pages28
JournalClinical Nutrition
Volume36
Issue number3
DOIs
Publication statusPublished - 01-06-2017

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Nutrition Policy
Perioperative Care
Guidelines
Preoperative Period
Early Ambulation
Muscle Proteins
Enteral Nutrition
Mechanical Ventilators
Postoperative Period
Malnutrition
Blood Glucose
Fasting
Therapeutics
Neoplasms

All Science Journal Classification (ASJC) codes

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

Cite this

Weimann, A., Braga, M., Carli, F., Higashiguchi, T., Hübner, M., Klek, S., ... Singer, P. (2017). ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition, 36(3), 623-650. https://doi.org/10.1016/j.clnu.2017.02.013
Weimann, Arved ; Braga, Marco ; Carli, Franco ; Higashiguchi, Takashi ; Hübner, Martin ; Klek, Stanislaw ; Laviano, Alessandro ; Ljungqvist, Olle ; Lobo, Dileep N. ; Martindale, Robert ; Waitzberg, Dan L. ; Bischoff, Stephan C. ; Singer, Pierre. / ESPEN guideline : Clinical nutrition in surgery. In: Clinical Nutrition. 2017 ; Vol. 36, No. 3. pp. 623-650.
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Weimann, A, Braga, M, Carli, F, Higashiguchi, T, Hübner, M, Klek, S, Laviano, A, Ljungqvist, O, Lobo, DN, Martindale, R, Waitzberg, DL, Bischoff, SC & Singer, P 2017, 'ESPEN guideline: Clinical nutrition in surgery', Clinical Nutrition, vol. 36, no. 3, pp. 623-650. https://doi.org/10.1016/j.clnu.2017.02.013

ESPEN guideline : Clinical nutrition in surgery. / Weimann, Arved; Braga, Marco; Carli, Franco; Higashiguchi, Takashi; Hübner, Martin; Klek, Stanislaw; Laviano, Alessandro; Ljungqvist, Olle; Lobo, Dileep N.; Martindale, Robert; Waitzberg, Dan L.; Bischoff, Stephan C.; Singer, Pierre.

In: Clinical Nutrition, Vol. 36, No. 3, 01.06.2017, p. 623-650.

Research output: Contribution to journalArticle

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AU - Klek, Stanislaw

AU - Laviano, Alessandro

AU - Ljungqvist, Olle

AU - Lobo, Dileep N.

AU - Martindale, Robert

AU - Waitzberg, Dan L.

AU - Bischoff, Stephan C.

AU - Singer, Pierre

PY - 2017/6/1

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N2 - Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice.

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Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S et al. ESPEN guideline: Clinical nutrition in surgery. Clinical Nutrition. 2017 Jun 1;36(3):623-650. https://doi.org/10.1016/j.clnu.2017.02.013