Impact of malnutrition on surgical outcomes

Malnutrition is a condition that arises from an imbalanced intake of nutrients, leading to deficiencies, excesses, or imbalances in a person's diet. The types of malnutrition include undernutrition such as wasting, stunting, and micronutrient deficiencies and overnutrition such as obesity and diet-related non-communicable diseases.
Nutritional deficiency or undernutrition, is a state that arises from poor nutrient intake and is one of the factors that affect surgical prognosis and postoperative healing.Even in the present era of sophisticated technology and refined surgical procedures, nutrition continues to be the foundation of the postoperative period and general well-being.
The Connection Between Malnutrition and Surgical Outcomes
Malnutrition is often underdiagnosed in surgical patients. Studies have shown that up to 50% of hospitalized patients are malnourished or at risk of malnutrition. This condition is particularly prevalent among the elderly, individuals with chronic diseases, and those undergoing major surgeries. Moreover, malnutrition can result from various factors, including poor dietary intake, chronic illnesses, and socio-economic conditions, all contributing to the body's weakened state before surgery.
Malnutrition hampers the body’s capacity to heal and resist infections. Proteins, vitamins and minerals are essential for healing wounds, boosting the immune system and improving the body’s metabolism. When a patient is malnourished, his or her body cannot produce the nutrients required for these important functions. Such a condition has various adverse effects on the body, including:
1) Delayed Wound Healing: Collagen is made of proteins and vitamins such as Vitamin C and Zinc which are used in the formation of tissues. Patients with poor nutritional status are likely to have delayed wound healing, which is a predisposing factor to wound infections and dehiscence.
2) Increased Infection Rate: A compromised immune system is one of the characteristics of malnutrition. Patients who have a weak immune system are vulnerable to infections after the surgery, which may prolong their healing process and require further treatment.
3) Muscle Wasting and Weakness: Post-surgery, patients need substantial energy and strength for basic activities. Malnutrition hampers muscle development and reduces muscle power, complicating mobility. This impedes essential movement to prevent conditions like deep vein thrombosis (DVT) and pneumonia.
4) Higher Mortality Rates: Several researches have indicated that poor nutrition is directly associated with high mortality in surgical patients. The inability to regain nutritional status after surgery can be fatal.

Preventing Malnutrition Through Proper Dietary Planning
Since malnutrition is a major factor that affects surgical outcomes, it is crucial to identify and treat preoperative and postoperative nutritional imbalances. Here are some key strategies to prevent malnutrition and improve surgical recovery through proper dietary planning:
Preoperative Nutritional Assessment: The nutritional status should be assessed before the surgery as a part of preoperative assessment. This makes it easy to identify patients who are likely to develop malnutrition and then take appropriate measures.
Individualized Nutritional Plans: The management of patients’ diets requires the development of individualized dietary prescriptions. This involves making sure that the required calories, proteins and other vitamins and minerals are taken in the right proportions.
Nutritional Support: At times, oral intake of foods may not be enough. Intravenous feeding or tube feeding may be necessary to provide nutrition to patients with severe malnutrition.
Postoperative Monitoring and Support: Postoperative nutritional status should be monitored regularly. Modifying the dieting plans based on the recovery process and addressing any new nutritional losses that may occur during the postoperative period can improve the recovery process.
Education and Counseling: Informing the patients and their families about the role of nutrition in the surgical recovery process can enhance compliance with the recommended diets.
Malnutrition is a major determinant that can affect surgical outcomes. By timely screening, personalized nutritional prescription, and sustained nutritional intervention, the detrimental consequences of malnutrition can be prevented and the quality of postoperative recovery can be improved. Thus, the focus on nutrition can help enhance the outcomes of surgeries and decrease the risks of complications in patients.
(Dr.V. Krishna Deepika Msc , foods Nutrition, Sr Clinical Dietician, Apollo Spectra Hospital, Hyderabad)