Updated October 2025
Perioperative Nutrition
Nutritional Optimization in Surgical Patients: Practical, Evidence-Informed Guidance
Malnutrition is common in surgical populations and is strongly associated with higher complications, longer length of stay, infections, and mortality. Evidence supports early screening, targeted protein-energy support, and early postoperative feeding to improve recovery metrics, wound healing, and functional outcomes, especially in high-risk and cardiac/major surgical patients.
Clinical question
What perioperative nutritional strategies improve outcomes in adult surgical patients, and how should clinicians implement screening, targets, and timing of support?
Perioperative MedicineNutritionEnhanced RecoveryCritical CareSurgery
Key points
Screen early and stratify risk
Use simple tools preoperatively to identify malnutrition risk and start optimization immediately; earlier support correlates with better postoperative healing and recovery [1], [3].
Prioritize protein and energy
Ensure adequate calories with high-protein intake to blunt catabolism, support wound healing, and limit functional decline after surgery [4], [5], [6].
Feed early after surgery when safe
Early postoperative nutrition (including in cardiac surgery) is feasible and associated with improved outcomes and shorter recovery in high‑risk patients [1], [2].
Integrate into ERAS pathways
Standardized perioperative nutrition bundles are acceptable, low‑risk, and can enhance recovery across elective surgical services [6], [7].
Tailor to illness severity
Critically ill and major trauma/major surgery patients need cautious, progressive support that matches metabolic stress to avoid under- or overfeeding [8].
Evidence highlights
≈20–50% (varies by case mix)
Malnutrition prevalence (major surgery)
Improves wound healing and recovery [1], [2]
Early feeding effect
Optimized nutrition improves clinical outcomes [2]
High-risk cardiac surgery
A Stepwise Approach to Perioperative Nutritional Optimization
Focus on early identification, targeted macronutrient delivery, micronutrient adequacy, and timely transition to oral feeds.
1
Screen within days to weeks pre-op
Use brief tools to flag malnutrition risk; refer to dietetics for those at risk. Early identification enables prehabilitation and reduces postoperative complications through timely support [3], [9], [6].
2
Set protein-energy targets
Aim for sufficient calories and high-quality protein to counter surgical stress. Adequate protein, vitamins, and trace elements are critical to tissue repair and immune function, improving wound healing and recovery duration [4], [5].
3
Start nutrition early post-op when feasible
Early postoperative nutrition improves wound outcomes and clinical recovery; in high-risk cardiac surgery, optimized strategies yield better clinical endpoints [1], [2].
4
Use multimodal supplementation
Combine oral nutritional supplements with micronutrient repletion (vitamins, trace elements) to support collagen synthesis, immune defense, and muscle preservation [4], [5].
5
Embed in ERAS and monitor
Integrate nutrition orders into perioperative order sets. Monitor intake, nitrogen balance proxies, weight/lean mass trends, and tolerance; adapt delivery to severity of illness to avoid overfeeding in critical care states [8], [6], [7].
Key Components and Practical Checks
Use these structured prompts to operationalize perioperative nutrition.
Preoperative Screening and Activation
Identify malnutrition risk early; involve dietetics for at-risk patients [3], [9].
Document baseline weight change, intake, and functional status; consider frailty assessment [6].
Initiate oral supplements and dietary counseling pre-op for malnourished patients [3], [9].
Macronutrient Priorities
Prioritize high-protein intake to mitigate catabolism and support wound healing [4], [5], [6].
Ensure adequate energy delivery while avoiding overfeeding in critical illness [8].
Advance from oral to enteral early post-op if intake insufficient; reserve parenteral if enteral not feasible [1], [8].
Micronutrients and Immune Support
Replete vitamins and trace elements essential for collagen maturation and immune response [4], [5].
Consider immunonutrition selectively based on institutional protocols; evidence remains evolving [3], [9].
Monitor for deficiencies post-op in prolonged NPO or high-loss states [8].
Timing and Route
Begin oral/enteral feeding within the early postoperative window if not contraindicated [1], [2].
For high-risk cardiac/major surgery patients, apply optimized early strategies to improve outcomes [2], [8].
Transition to full oral diet with continued supplements as tolerance improves [6], [7].
Special Populations and Risks
Critically ill or hemodynamically unstable patients: start low, go slow; avoid overfeeding during peak stress [8].
Monitor for refeeding syndrome in severely malnourished; correct electrolytes proactively [8].
Tailor to renal/hepatic dysfunction and glycemic control needs [8], [6].
Outcome Tracking
Track wound healing, infection rates, LOS, and readmission; early support is associated with improved wound outcomes [1].
In cardiac surgery, monitor ICU days and complications; optimized nutrition can improve clinical endpoints [2].
Assess functional recovery and weakness reduction as part of prehab/rehab programs [6], [7].
References
Source material
Primary literature that informs this article.
The impact of early nutritional support on postoperative ...
onlinelibrary.wiley.com
clinical application of early postoperative nutritional ...
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Nutritional Optimization of the Surgical Patient: A Narrative ...
pubmed.ncbi.nlm.nih.gov
Role of nutritional support in nursing practice for improving ...
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Nutritional Requirements for Optimal Surgical Recovery
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reducing critical illness weakness across elective surgical ...
pmc.ncbi.nlm.nih.gov
Adoption and acceptability of a perioperative nutrition ...
pmc.ncbi.nlm.nih.gov
The critical role of nutritional support in trauma, major ...
link.springer.com
Optimizing Nutritional Status of Patients Prior to Major ...
pubmed.ncbi.nlm.nih.gov