Support nutritionnel préopératoire : qui, quand, comment ?

Malnutrition defined as a weight loss more than 10% in 3 months induced organ dysfunctions. In major surgical procedures, theses disturbances are associated with an increase in postoperative complications, mortality, length of stay and costs. Usually, nutritional status should be evaluated early, in each patient, scheduled for a major surgical intervention by estimation of the weight loss and eventually by the measure of albuminemia and an estimation of SGA and NRI. Several clinical studies have shown that preoperative parenteral nutrition is efficacious to prevent postoperative complications in severely malnourished patients. In non-malnourished patients, preoperative parenteral nutrition is deleterious inducing an increase in septic complications. Only, few studies have evaluated enteral nutrition and oral complementation. In malnourished patients, enteral nutrition seems to be effective to diminished postoperative complications. Concerning conventional oral complementation, there is no well done study. Seven to 10 days of nutritional support are necessary to obtain a postoperative effect and influence the outcome. This nutritional support should be initiated early to avoid a delay in surgical procedure.