The perioperative period presents a critical window in which nutrition influences surgical outcomes, recovery trajectories, and overall patient survival. Malnutrition, whether overt or subclinical, is a prevalent and often underestimated risk factor among surgical patients. Numerous studies have demonstrated that inadequate nutritional status prior to surgery increases the likelihood of postoperative complications, including infections, delayed wound healing, and prolonged hospital stays. As such, the integration of nutritional assessment and optimization strategies into perioperative care protocols is imperative for enhancing patient outcomes and reducing healthcare costs.

Perioperative nutrition encompasses interventions before, during, and after surgery aimed at mitigating the catabolic stress induced by surgical trauma. Surgical procedures elicit a physiological stress response that includes increased metabolic rate, insulin resistance, and inflammatory mediator release, all of which elevate protein and energy requirements. When these needs are unmet due to malnutrition, the result is often a deterioration in functional status, increased morbidity, and greater risk of postoperative complications. A recent narrative review emphasized the need for preoperative nutritional optimization, particularly among high-risk populations such as the elderly, oncology patients, and individuals with chronic illnesses (1).

Screening tools like the Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA) have been validated for identifying patients at nutritional risk. Early detection allows clinicians to implement interventions such as oral nutritional supplements, enteral nutrition, or even parenteral support in severe cases. One multicenter retrospective cohort study validated a machine learning-based tool that outperformed traditional methods in predicting malnutrition-related surgical risks, suggesting a new frontier in personalized perioperative care (2).

Evidence also supports the role of perioperative immuno-nutrition (nutritional formulations enriched with arginine, omega-3 fatty acids, and nucleotides) in reducing infectious complications and hospital stays. These specialized interventions are particularly beneficial in gastrointestinal and oncologic surgeries where mucosal immunity and gut barrier integrity are vital. Furthermore, prehabilitation strategies, which are structured programs combining nutrition, physical activity, and psychological support prior to surgery, have gained traction for improving postoperative outcomes.

Importantly, postoperative nutritional care must not be neglected. Early enteral feeding within 24 hours post-surgery, when necessary and feasible, is associated with faster recovery, lower infection rates, and reduced muscle wasting. Nutritional interventions during this phase must be individualized, taking into account the patient’s metabolic status, organ function, and ability to tolerate various routes of nutrition. A 2024 systematic review focused on frail elderly patients highlighted that multicomponent interventions, including tailored nutrition plans, significantly improved functional recovery and reduced postoperative complications (3).

Despite the wealth of evidence supporting the need for enhanced nutrition care in the perioperative period, its implementation remains inconsistent across healthcare systems. Barriers include lack of standardized protocols, insufficient interdisciplinary collaboration, and limited awareness among surgical teams (1). Moreover, the development of innovative tools, such as machine learning-based nutritional risk screeners, has shown promise in improving early detection and intervention planning, especially when integrated with electronic health record systems.

In summary, perioperative nutrition is a cornerstone of surgical care that significantly influences patient outcomes. A proactive, multidisciplinary approach encompassing early screening, individualized interventions, and integration of emerging technologies is essential to fully realize its benefits.

References

1. Heutlinger O, Acharya N, Tedesco A, et al. Nutritional Optimization of the Surgical Patient: A Narrative Review. Adv Nutr. 2025;16(1):100351. doi:10.1016/j.advnut.2024.100351
2. Parchure P, Besculides M, Zhan S, et al. Malnutrition risk assessment using a machine learning-based screening tool: A multicentre retrospective cohort. J Hum Nutr Diet. 2024;37(3):622-632. doi:10.1111/jhn.13286’
3. Gordon EH, Mayhew AJ, Baxter M, et al. Multicomponent perioperative interventions to improve outcomes for frail patients: a systematic review. BMC Geriatr. 2024;24(1):376. doi:10.1186/s12877-024-04985-4
4. Rola J, Gibbs H, Robertson H, et al. The Development of a Video-based Nutrition Education Curriculum for Patients Undergoing Radical Cystectomy. Bladder Cancer. 2023;9(2):151-157. Published 2023 Jun 27. doi:10.3233/BLC-230021

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