Nutrition

Created: June 28, 2021

Last Updated: November 18, 2023

Contributor(s):

Katie Davis RD LDN CNSC

Christian Stoppe MD FESC FAHA

ERAS Cardiac Collaborative Network

Editor(s):

Cheryl Crisafi MSN RN CNL

Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC

Gina McConnell RN BSN CCRN

Shannon Crotwell RN BSN CCRN

Alexander Gregory MD FRCPC

Summary

Nutrition screening and optimization in cardiac surgery involve a systematic assessment and improvement of patients' nutritional status before and after surgery. This approach aims to mitigate the risk of malnutrition-related complications, promote faster recovery, and enhance overall surgical outcomes. It necessitates a multidisciplinary approach and personalized care to address each patient’s unique nutritional needs effectively.

Nutrition plays a pivotal role in the preparation and recovery of patients undergoing cardiac surgery. Proper nutrition screening and optimization aim to identify and mitigate nutritional deficiencies, enhance patients' overall health, and promote faster recovery post-surgery.

Nutrition optimization involves many important components:

Nutrition Screening:

  • Early assessment of patients’ nutritional status to identify deficiencies or malnutrition that can affect surgical outcomes.
  • Use of validated screening tools like the Nutrition Risk Screening 2002 (NRS 2002) or the Malnutrition Universal Screening Tool (MUST) to evaluate patients’ nutritional needs.
  • In-depth examination of dietary intake, weight, body mass index (BMI), and laboratory markers like albumin levels.

Nutritional Optimization:

  • Development of tailored nutritional plans to address identified deficiencies, considering patients’ specific needs and preferences.
  • Enhancement of nutritional intake before surgery to bolster patients’ immune system, wound healing, and overall resilience.
  • Addressing deficiencies in vitamins and minerals to optimize metabolic functions and immune response.

Benefits of Nutritional Optimization:

  • Enhanced nutritional status correlates with reduced postoperative complications and improved wound healing.
  • Well-nourished patients often experience quicker recoveries and shorter hospital stays.
  • Proper nutrition supports immune function, reducing the risk of infections post-surgery.

Postoperative Nutrition:

  • Initiation of nutritional intake as soon as safely possible after surgery to support recovery.
  • Provision of a balanced diet rich in protein, vitamins, and minerals to support wound healing and restore body functions.
  • Continuous monitoring and adjustment of nutritional plans based on patients’ recovery progress and emerging needs.

Multidisciplinary Approach:

  • Involvement of physicians, dietitians, nurses, and other healthcare professionals to ensure comprehensive nutritional care.
  • Educating patients and families on the importance of nutrition and providing support to adhere to nutritional recommendations.

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This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

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The VTC, and all included content, is intended to inform ERAS Cardiac Members in a multitude of topics related to enhanced recovery. The information included has been provided by other enhanced recovery experts and should be used for educational purposes only. It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered as formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information on the VTC is accurate or complete in every respect. Therefore, ERAS Cardiac Society is not responsible for any errors or omissions in the content, or medical results that occur with the application of the information obtained while using the VTC. All healthcare professionals should continue to use sound clinical judgment and prescribe therapies based on the best medical knowledge at their disposal.

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Educational Materials

Nutrition Support in Cardiac Surgery Patients
Prof. Christian Stoppe provides a comprehensive summary of the evidence supporting nutrition optimization throughout the perioperative phases-of-care in cardiac surgery.
Nutrition Optimization in the Pre-op Cardiac Surgery Patient
Katie Davis, from the University of Maryland, provides us with a dietician's insights and perspective on pre-operative nutrition optimization.
Nutrition Optimization: Pre-operative Phase
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss nutritional optimization in the pre-operative phase.
Nutrition Optimization: Post-operative Phase
This video is a recorded session from the ERAS Cardiac Virtual Meeting in 2021. Speakers and discussants include members of our international network of ERAS experts. In this session, participants discuss nutritional optimization in the post-operative phase.

References:

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18. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures: An Updated Report by the American Society of Anesthesiologists Task Force on Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Anesthesiology. 2017;126:376-393.

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