Perioperative nutritional management of elderly patients

The nutritional status of patients undergoing surgery is very relevant as it represents a modifiable risk factor for postoperative outcomes. Malnutrition is frequent among elderly patients, which often carry other overlapping conditions such as comorbidities and poor functional status. For this reason, it is very important to screen patients preoperatively for nutritional and functional status and tailor perioperative strategies accordingly. Malnourished patients can be identified through simple screening tools that include questions focused on BMI, weight loss, and dietary intake. Surgery may also be delayed to implement a nutritional intervention to potentially reduce postoperative morbidity. Preoperative nutritional interventions to enhance patient nutritional status aim at meeting an adequate protein target by improving diet or adding high-protein oral nutritional supplements, since proteins are the most used substrate in surgical stress situations. If the oral route is not effective, nutritional interventions include enteral feeding and parenteral nutrition. During surgery, the nutritional support needed for postoperative recovery should be anticipated, and effective strategies include positioning of a naso-enteric feeding tube, a needle catheter jejunostomy, or a central venous line. Postoperatively, oral or enteral feeding can be initiated early to reach enough calorie and protein intake, which is essential to promote anabolism and functional recovery. Using the gut to feed the patients is extremely important in order to preserve the immune response and the intestinal barrier. However, parenteral nutrition should also be considered early after surgery if it is difficult to reach the nutritional targets via the enteral route. Elderly patients undergoing emergency surgery represent a specific group of patients at very high risk for postoperative poor outcomes and prolonged recovery. Nutritional support and follow-up should then continue throughout hospital stay, but also after discharge in an outpatient setting.