American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway.
Abstract
Perioperative malnutrition has proven to be challenging to define, diagnose, and treat.
Despite these challenges, it is well known that suboptimal nutritional status is a
strong independent predictor of poor postoperative outcomes. Although perioperative
caregivers consistently express recognition of the importance of nutrition screening
and optimization in the perioperative period, implementation of evidence-based perioperative
nutrition guidelines and pathways in the United States has been quite limited and
needs to be addressed in surgery-focused recommendations. The second Perioperative
Quality Initiative brought together a group of international experts with the objective
of providing consensus recommendations on this important topic with the goal of (1)
developing guidelines for screening of nutritional status to identify patients at
risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing
nutritional support and optimizing nutrition status preoperatively; and (3) identifying
when and how to optimize nutrition delivery in the postoperative period. Discussion
led to strong recommendations for implementation of routine preoperative nutrition
screening to identify patients in need of preoperative nutrition optimization. Postoperatively,
nutrition delivery should be restarted immediately after surgery. The key role of
oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented
in that order) in most perioperative patients was advocated for with protein delivery
being more important than total calorie delivery. Finally, the role of often-inadequate
nutrition intake in the posthospital setting was discussed, and the role of postdischarge
oral nutrition supplements was emphasized.
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https://hdl.handle.net/10161/16036Published Version (Please cite this version)
10.1213/ANE.0000000000002743Publication Info
Wischmeyer, Paul E; Carli, Franco; Evans, David C; Guilbert, Sarah; Kozar, Rosemary;
Pryor, Aurora; ... Perioperative Quality Initiative (POQI) 2 Workgroup (2018). American Society for Enhanced Recovery and Perioperative Quality Initiative Joint
Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced
Recovery Pathway. Anesth Analg. 10.1213/ANE.0000000000002743. Retrieved from https://hdl.handle.net/10161/16036.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Timothy Ellis Miller
Professor of Anesthesiology
Clinical and research interests are Enhanced Recovery and Perioperative Medicine;
with particular interests in fluid management, and perioperative optimization of the
high-risk non-cardiac surgery patient.
Julie K. Marosky Thacker
Associate Professor of Surgery
Paul Edmund Wischmeyer
Professor of Anesthesiology
Paul Wischmeyer M.D., EDIC, FASPEN, FCCM is a critical care, perioperative, and nutrition
physician-researcher who specializes in enhancing preparation and recovery from surgery,
critical care and COVID-19. He serves as a Tenured Professor of Anesthesiology and
Surgery at Duke. He also serves as the Associate Vice Chair for Clinical Research
in the Dept. of Anesthesiology and Director of the TPN/Nutrition Team at Duke. Dr.
Wischmeyer earned his medical degree with honors at T
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