Introduction

INTRODUCTION

Optimal nutritional status, both pre- and postoperatively , is a key factor in reducing perioperative complications and improving surgical outcomes. However, the pathologies requiring surgical intervention often contribute to malnutrition, and a lack of appreciation of preoperative nutritional status can unnecessar ily increase the risk of the operation and compromise recovery from surgery ( Figure 25.1 ). Some operations, particularly Carl Ferdinand Cori , 1896–1984, Professor of Pharmacology and later Biochemistry , Washington University Medical School, St Louis, MI, USA, and his wife Gerty Theresa Cori , 1896–1957, also Professor of Biochemistry at the Washington University Medical School. In 1947, the Coris were awarded a share of the Nobel Prize in Physiology or Medicine for their discovery of how glycogen is catalytically converted. abdominal operations, can compromise absorption from the gastrointestinal tract, at least temporarily if not permanently . It is therefore imperative that the e ff ects of surgical intervention on the patient’s nutritional status are taken into consideration perioperatively , and appropriate intervention taken as early as possible to correct any nutritional deficits. - Appreciation of the importance of nutritional status is becoming more widespread within the healthcare profession and many tools have been developed to help identify poor nutritional status. These assessment tools and the availability of improved options for both enteral and parenteral delivery of nutrients allows any nutritional deficiency to be expeditiously identified and corrected until normal intestinal absorption can resume.

Figure 25.1 Severely malnourished patient with evidence of fat and muscle wasting. The causes and complications of malnutrition and their • management The options for nutritional intervention and the indications • for enteral versus parenteral nutritional support