Targeted Preoperative Nutritional Support within an Enhanced Recovery After Surgery Program for Malnourished...

Malnutrition is associated with poor surgical outcomes, but evidence supporting targeted nutritional intervention within multimodal pathways remains limited. We assessed whether preoperative nutritional support, delivered selectively to malnourished colorectal cancer patients within an Enhanced Recovery After Surgery (ERAS) framework, was associated with postoperative outcomes comparable to those of well-nourished patients.

We conducted a prospective observational cohort study in an ERAS-certified Spanish hospital between January 2020 and December 2021. A total of 187 consecutive adult patients undergoing elective primary colorectal cancer resection were screened for malnutrition by using Malnutrition Universal Screening Tool and Global Leadership Initiative on Malnutrition criteria. Malnourished patients received individualized nutritional counseling and oral nutritional supplements ≥ 7 days preoperatively, per ESPEN guidelines. Primary outcomes were length of stay (LOS) and 30-day postoperative complications. Multivariable logistic and Cox regression models adjusted for age, sex, body mass index, American Society of Anesthesiologists class, and nutritional status.

The cohort's mean age was 69.3 ± 9.6 years, 62.6% were male, and 42 (22.4%) were diagnosed with malnutrition. No significant differences were observed in complication rates (38.1% vs. 31.7%, P = 0.276) or LOS (median 8 vs. 7 days, P = 0.36) between malnourished and well-nourished groups. In multivariable analysis, malnutrition was not independently associated with postoperative complications (adjusted odds ratio 1.47; 95% confidence interval 0.7-3.07; P = 0.31) or prolonged LOS (adjusted odds ratio 0.77; 95% confidence interval 0.53-1.12; P = 0.17). No 30-day deaths occurred.

Within a structured ERAS program, targeted preoperative nutritional support was associated with postoperative outcomes that were not worse than those of well-nourished peers. These findings support a selective "screen-and-treat" nutritional strategy in routine perioperative care.