Comment dépister et prendre en charge la dénutrition en périopératoire ?

Malnutrition in the adult surgical patient may impair outcome. It is therefore necessary to assess nutritional status with regard to surgery, using a specific scoring. In the absence of nutritional risk factor in scheduled surgery without large metabolic strain, careful supervision of postoperative food intake is allowed only, under the conditions of uncomplicated surgical outcome. Nutritional care may thereafter be indicated due to nutritional risk factors or requirements from surgery: prolonged fasting, complications including infectious ones. Energy intake (including protein intake) is based on the current recommendations: 25-30 kcal/kg per day (and 1.2 to 1.5 g/kg per day). The systematic provision of vitamins and trace elements is justified only in case of extended artificial nutrition in the absence of pre-existing deficiency. The enteral feeding route must be favored as soon as possible. In case of parenteral nutrition in routine postoperative management, the advantage of medium chain fatty acids, of fatty acids from fish oil and of glutamine is unclear. Nutritional management includes a comprehensive clinical supervision and a careful postoperative management of blood glucose based on intensive insulin therapy.