Subject: Participation in “Peri-op nutrition-market research survey”
Major surgery evokes a catabolic response that results in inflammation, protein catabolism and nitrogen losses. This response is proportional to the magnitude of the surgery/procedure and in some instances, can be detrimental to the patient, especially when there is pre-existing malnutrition. Traditional perioperative care has involved measures that starve the patient for prolonged periods of time, stress the patient with interventions that amplify the catabolic response and drown the patient with salt and water overload.
Surgical patients may present with varying degrees of malnutrition, sarcopenia, cachexia, obesity and myosteatosis. In prospective studies, patients with better pre-operative physical function and lower pain generally achieved a better recovery after surgery. Patients with poor physical function before surgery may have greater absolute improvement. Malnutrition has been recognized as a major risk factor for adverse postoperative outcomes. There have been studies that have analyzed the incidence of malnutrition in patients undergoing various surgeries, however there is limited literature on malnutrition among Indian patients undergoing surgeries/ procedures.
A simple bedside nutritional assessment tools and investigations like hemoglobin, serum albumin/ serum proteins, absolute lymphocyte count, etc. can accurately identify malnourished patients preoperatively and are good predictors of postoperative complications. Hence, it is imperative to assess and attempt to improve the nutritional status of the patients preoperatively.
Pre-operative optimization can help improve outcomes. Wherever feasible, enteral route is always preferred and even when patients are consuming a normal diet this is frequently insufficient to obtain their energy requirement, so it is recommended that patients receive nutritional support including oral nutritional supplements (ONS) in the preoperative period, irrespective of their nutritional status.
At present, there are significant gaps in understanding the clinical needs of peri-operative malnourished patients across India. Like ESPEN globally, currently no uniform recommendations exist across surgical therapies considering Indian scenario while there have been discussions on geographical differences in dietary patterns, need for peri-op nutritional support.
We are planning to understand clinical scenario over peri-op nutrition in India. If you agree to participate, you will be required to respond to questions of the enclosed questionnaire. We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this survey. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.
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