A 68-year-old man is being assessed for major colorectal surgery. Pre-operative nutritional assessment shows severe malnutrition (NRS-2002 score ≥5, serum albumin 25 g/L, BMI 17, weight loss 12% in 3 months). He has no signs of intestinal obstruction. The ESPEN 2017 guideline recommendation for pre-operative nutritional support in this severely malnourished patient is:
- A Proceed to surgery immediately; start post-operative parenteral nutrition
- B Delay elective surgery by 7-14 days to provide pre-operative oral/enteral nutritional support (immune-enhanced if possible) ✓
- C Start total parenteral nutrition (TPN) for 7 days then operate
- D No specific nutritional intervention needed before colorectal surgery
Explanation
ESPEN 2017 guidelines recommend that severely malnourished patients (NRS-2002 ≥5 or major nutritional risk) undergoing elective major surgery should receive 7-14 days of pre-operative nutritional support — preferably oral nutritional supplements or enteral nutrition — before surgery, even if this delays the procedure. This 'prehabilitation nutrition' reduces postoperative complications (anastomotic leak, SSI, delayed wound healing). Oral immunonutrition (containing arginine, omega-3 fatty acids, nucleotides) for 5-7 days pre-operatively is recommended before major elective colorectal surgery (ESPEN/ERAS guidelines). TPN is reserved when enteral/oral routes are not feasible. Proceeding to surgery in severe malnutrition dramatically increases postoperative complications.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.