ESPEN Guidelines on Parenteral Nutrition: surgery

Area of Science:

• Surgical Nutrition
• Enhanced Recovery Protocols
• Perioperative Care

Background:

• Modern surgery emphasizes enhanced recovery protocols, enabling patients to resume normal eating within 1-3 days.
• Routine perioperative artificial nutrition is generally not indicated due to rapid oral intake.
• Artificial nutrition is reserved for a minority of surgical patients at risk of complications.

Purpose of the Study:

• To outline the goals of perioperative nutritional support, including minimizing negative protein balance and maintaining function.
• To review the evidence for preoperative and postoperative artificial nutrition.
• To provide guidance on appropriate feeding methods and caloric requirements.

Main Methods:

• Review of existing studies on perioperative nutritional support.
• Analysis of outcomes associated with preoperative and postoperative artificial nutrition.
• Discussion of feeding modalities (enteral vs. parenteral) and caloric calculations.

Main Results:

• Preoperative parenteral nutrition (7-10 days) benefits severely undernourished patients unable to feed orally or enterally.
• Artificial nutrition in well-nourished or mildly undernourished patients offers no benefit and may increase morbidity.
• Postoperative parenteral nutrition is indicated if oral/enteral intake is insufficient for 7-10 days.

Conclusions:

• Enteral feeding or combined enteral and parenteral feeding is preferred for postoperative artificial nutrition.
• Parenteral nutrition requires careful administration of fats and carbohydrates to avoid overfeeding, with specific caloric estimates provided.
• Supplementation of vitamins and trace elements is crucial for patients requiring total or near-total parenteral nutrition post-surgery.