Perioperative nutritional status in cardiac surgery patients: a multicenter observational study in Shanghai, China

Cardiovascular disease is an escalating global health concern, leading to an increasing demand for cardiac surgeries. Nutrition plays a critical role during the perioperative period. Enhanced Recovery After Surgery (ERAS) protocols emphasize the importance of early gastrointestinal function restoration. Among nutritional metrics, protein intake is more closely associated with improved outcomes than total energy intake. This study aims to assess perioperative protein intake in cardiac surgery patients and identify factors associated with malnutrition.

In this prospective observational study, 197 patients undergoing elective cardiac surgeries at two hospitals in Shanghai were enrolled. Protein intake during the first 7 postoperative days was measured using 24-h dietary recall. Nutritional status was evaluated using the NRS-2002 score and serum albumin levels on admission, as well as on postoperative day 3 and 7. Generalized estimating equations (GEE) were used to identify predictors of malnutrition.

The average protein intake was 0.58 ± 0.24 g/kg/day, which was below the recommended 1.5 g/kg/day, with only 4.1% of patients meeting this target. Advanced age (OR = 1.045, 95% CI: 1.026-1.065, p < 0.05) and elevated white blood cell count (OR = 1.195, 95% CI: 1.127-1.266, p < 0.05) were identified as independent risk factors for malnutrition. The use of oral nutritional supplements (ONS) was protective (OR = 0.628, 95% CI: 0.4-0.988, p < 0.05). Patients with malnutrition on postoperative day 7 had significantly longer hospital stays (p < 0.05).

Patients undergoing cardiac surgery frequently experience significant perioperative protein deficits. Early nutritional intervention, particularly for elderly patients or those with elevated inflammatory markers, may help reduce malnutrition and enhance recovery.