Promoting perioperative metabolic and nutritional care
Abstract
AbstractAbstract: Surgery represents a major stressor that disrupts homeostasis and can lead to loss of body cell mass. Integrated, multidisciplinary medical strategies, including enhanced recovery programs and perioperative nutrition support, can mitigate the surgically induced metabolic response, promoting optimal patient recovery following major surgery. Clinical therapies should identify those who are poorly nourished before surgery and aim to attenuate catabolism while preserving the processes that promote recovery and immunoprotection after surgery. This review will address the impact of surgery on intermediary metabolism and describe the clinical consequences that ensue. It will also focus on the role of perioperative nutrition, including preoperative nutrition risk, carbohydrate loading, and early initiation of oral feeding (centered on macronutrients) in modulating surgical stress, as well as highlight the contribution of the anesthesiologist to nutritional care. Emerging therapeutic concepts such as preoperative glycemic control and prehabilitation will be discussed. This article is a narrative review that focuses on the role of perioperative nutrition in modulating the surgical stress response, as well as the contribution of the anesthesiologist to nutritional care. Preoperative nutrition risk, carbohydrate loading, early initiation of oral feeding, anesthetic strategies to facilitate nutritional gains, preoperative glycemic control, and prehabilitation will be addressed.
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Albumin <3.0 g/dL and prealbumin ≤20 mg/dL have been used as acute-phase markers to trigger nutritional supplementation within 1 week of surgery, although they are not good markers of nutritional status.
“Although not good markers of nutritional status, albumin <3.0 g/dL and prealbumin ≤20 mg/dL have been used as acute-phase markers to trigger nutritional supplementation within 1 week of surgery.186,189–191”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [191]
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Popescu, G. A., Mincă, D. G., Jafal, M., Toma, C. V., Alexandrescu, S. T., Costea, R., & Vasilescu, C. (2025) · Medicina · doi:10.3390/medicina61050908 · Cited by 21 · see citing works
“These pathways induce the catabolism of glycogen, fat and proteins, releasing glucose, free fatty acids and amino acids, which are substrates for the production of inflammatory phase proteins that contribute to healing and immune response [1,2].”
Christopher, C. N., Kang, D., Wilson, R. L., Encabo, P. G., Ficarra, S., Heislein, D. M., & Dieli-Conwright, C. M. (2023) · Nutrients · doi:10.3390/nu15245044 · Cited by 26 · see citing works
“This depletion can negatively impact their ability to tolerate surgical stress, leading to poor post-operative outcomes, an increased risk of infections, and further declines in skeletal muscle mass and fitness [74,75].”
BackgroundAssociation Between Intraoperative Blood Glucose and Anastomotic Leakage in Colorectal Surgery
Reudink, M., Huisman, D. E., van Rooijen, S. V., Lieverse, A., Kroon, H., Roumen, R., Daams, F., & Slooter, G. (2021) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-021-04933-2 · Cited by 21
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“Introducing a balanced diet with appropriate nutritional supplementation early in the post-operative period along with establishing a comprehensive long-term nutrition plan is important for the patient’s recovery and overall well-being [3,59].”
Modifying the Stress Response - Perioperative Considerations and Controversies.
Kelliher, L., & Scott, M. (2022) · Anesthesiology Clinics · doi:10.1016/j.anclin.2021.11.012 · Cited by 20
Chen, X.-R., Li, K., Yang, K., Hu, J.-K., Yang, J., Feng, J.-H., Hu, Y.-J., & Zhang, X. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.03.002 · Cited by 20 · see citing works
Surgery after neoadjuvant immunotherapy in patients with resectable non-small cell lung cancer
Huynh, C., Walsh, L. A., & Spicer, J. D. (2021) · Translational Lung Cancer Research · doi:10.21037/tlcr-20-509 · Cited by 23 · see citing works
“Neoadjuvant window therapy offers many opportunities for improvement, including optimization of patient performance status via exercise and tailored nutritional programs (116-118).”
BackgroundContemporary Perioperative Nutritional Care
Ljungqvist, O. H., Weimann, A., Sandini, M., Baldini, G., & Gianotti, L. V. (2024) · Annual Review of Nutrition · doi:10.1146/annurev-nutr-062222-021228 · Cited by 23 · see citing works
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“The surgery itself, like any other injury or damage, causes a series of reactions that include the release of stress hormones and inflammatory mediators such as cytokines, causing malnutrition in a few days [64].”
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“Major surgery represents a significant trauma to patients, eliciting the release of stress hormones and inflammatory mediators which result in the catabolism of glycogen, protein and lipid to facilitate healing [dataset [1,19,20]].”
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“In combination with the catabolic stress response and loss of skeletal muscle mass induced by bed rest [3], this places inactive, deconditioned patients at increased risk of postoperative complications.”
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“The body prioritizes immune response and glycemic control, forcing amino acids out of the muscles [62, 70, 71].”
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“metabolic and functional reserves [31].”
Regional Analgesia for Cardiac Surgery. Part 2: Peripheral Regional Analgesia for Cardiac Surgery
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“Gillis 2015 Gillis C, Carli F. Promoting perioperative metabolic and nutritional care.”
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“Surgery is a catabolic insult; enduring this is difficult, particularly for older and malnourished patients having poor functional reserves before surgery [37].”
BackgroundDemystifying Malnutrition to Improve Nutrition Screening and Assessment in Oncology
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“The following questions were asked in our pre-pamphlet group: (1) when was your last fluid intake prior to surgery and what did you drink? (2) when was your last solid meal prior to surgery and what did you eat? (3) were you hungry prior to your caesarean section? (4) if you were given the option of drinking a liquid…”
BackgroundInfluentialVest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Enhanced recovery after surgery, current, and future considerations in head and neck cancer
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“124 128 Following the recommendation of the Society of Sarcopenia, Cachexia, and Wasting Disorders, sarcopenic patients should be instructed to undergo progressive resistance training two to three times a week to increase muscle mass and function.”
BackgroundImpact of Frailty in Cardiac Surgical Patients—Assessment, Burden, and Recommendations
Shanker, A., Upadhyay, P., Rangasamy, V., Kanchi, M., & Subramaniam, B. (2021) · Annals of Cardiac Anaesthesia · doi:10.4103/aca.aca_90_20 · Cited by 14 · see citing works
“summarize the important role that perioperative nutrition can play in modulating the surgical stress response.[29] Severe malnutrition is defined by the European Society for Clinical Nutrition and Metabolism (ESPEN) when one of the following is present: weight loss more than 10 to 15% within 6 months; body mass index…”
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Multimodal Prehabilitation for Gynecologic Cancer Surgery
Kim, J., Lee, C. H., & Yim, G. W. (2025) · Current Oncology · doi:10.3390/curroncol32020109 · Cited by 14 · see citing works
“A substantial proportion of these gynecologic cancer patients need surgical treatment, and surgery itself causes metabolic and physiological stress [2].”
Wijma, A., Hogenbirk, R., Driessens, H., Kluifhooft, D. A., Jellema-Betten, E., Vries, M. T.-D., Liem, M., Nieuwenhuijs, V., Manusama, E., Hoogwater, F., et al. (2024) · Supportive Care in Cancer · doi:10.1007/s00520-024-08683-0 · Cited by 14 · see citing works
“The role of surgery-induced trauma in triggering the catabolic response, leading to a loss of muscle mass in the postoperative period, is widely recognized [41].”
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- Authors
- Gillis, C., & Carli, F.
- Affiliations
- McGill University Health Centre (CA)
- Corresponding author
- Carli, Francesco
- Venue
- Anesthesiology
- Published
- 2015-12
- Volume
- 123
- Issue
- 6
- Pages
- 1455-1472
- ISSN
- 0003-3022 (ISSN-L)
- OpenAlex
- W1905230518
- Cited by
- 350
- References
- 0
- Citations by year
- 2026: 44 · 2025: 38 · 2024: 56 · 2023: 51 · 2022: 44 · 2021: 31 · 2020: 34 · 2019: 18 · 2018: 15 · 2017: 11 · 2016: 7
- FWCI
- 2.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- McGill University Health Centre
- Topics
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- perioperative nutrition, enhanced recovery after surgery, surgical stress response, intermediary metabolism, catabolism, carbohydrate loading, early oral feeding, prehabilitation, preoperative glycemic control, immunoprotection, malnutrition
- MeSH terms
- Humans, Nutritional Status, Postoperative Complications, Preoperative Care, Surgical Procedures, Operative, Nutritional Support, Perioperative Care
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