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Nutrition

Related theory

For normally nourished patients, the primary objective of post‐operative care is restoration of normal GI function to allow adequate food and fluid intake and rapid recovery. Prolonged delays in oral feeding may compromise post‐operative nutrition, which can lead to poor wound healing, susceptibility to infection and the need for nutritional support (Litkouhi [107], NICE [142]). Post‐operatively, energy and protein requirements depend on body composition, clinical status and mobility. Surgery places the body under extraordinary stressors (e.g. hypovolaemia or hypervolaemia, bacteraemia, and medications) and wound healing requires the intake of appropriate vitamins and minerals (e.g. vitamin A, vitamin C and zinc) and adequate calories from protein (see Chapter c08: Nutrition and fluid balance).

Evidence‐based approaches

Principles of care

Surgery may exert a detrimental effect on appetite and the ability to maintain adequate nutritional intake post‐operatively. Causative factors include:
  • the surgery itself
  • post‐operative nausea and vomiting
  • anorexia
  • altered bowel movements (e.g. constipation, ileus or diarrhoea)
  • medication
  • oral candida
  • sore mouth
  • dysphagia
  • early satiety.
Unless contraindicated by the surgery performed (e.g. major abdominal or head and neck surgery) or the patient's current clinical status (e.g. risk of pulmonary aspiration, vomiting and/or ileus), the majority of patients will be able to meet their nutritional requirements orally in the post‐operative period. If clinically indicated, any food or drink taken by the patient should be accurately recorded (volume and type of food) on a food chart and fluid balance chart. It is essential that appropriately trained healthcare professionals do the following:
  • undertake ongoing oral and nutritional screening assessments in accordance with local trust policy
  • put preventive measures in place (e.g. providing good oral hygiene, offering appetizing food and drink, and providing assistance with eating and drinking)
  • alert the dietician and/or surgeon when there is cause for concern.
Any patient unable to meet their nutritional requirements orally will require referral to a dietician, who will assess the patient's nutritional requirements and tailor any nutritional replacement – whether oral (e.g. nutritional supplements), enteral or parenteral – to their needs.
Post‐operative nutritional support has potentially serious complications (NICE [147]). Enteral nutrition uses the physiological route of nutrient intake, is cheaper and is generally safer, and should be the preferred method of nutritional support, in the presence of a functioning GI tract (Weimann et al. [221]). Types of enteral feed tubes include nasogastric, nasoduodenal, nasojejunal, gastrostomy and jejunostomy. While enteral feeding is the preferred route of nutritional support (NICE [147]), parenteral nutrition may be indicated for some post‐operative patients who have undergone major abdominal surgery or those with prolonged ileus, uncontrolled vomiting or diarrhoea, short bowel syndrome or GI obstruction.
More detailed information can be found in the Chapter c08: Nutrition and fluid balance.
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