S3-Guideline Clinical Nutrition in Surgery of the German Society for Nutritional Medicine (DGEM)

The avoidance of pronounced catabolism after surgical interventions with early postoperative diet build-up and mobilization for rapid convalescence is today the standard of perioperative management in the so-called Enhanced Recovery After Surgery (ERAS). Thus, early oral nutrition is also the preferred form of postoperative nutrition. However, measured in terms of caloric requirements, reduced food intake can be assumed for a longer period of time, especially after surgery on the upper gastrointestinal tract. This fundamentally carries the risk of progressive weight loss and patient malnutrition during the postoperative course. Malnutrition and undernutrition are significant risk factors for postoperative complications. Thus, early enteral nutrition is particularly important for surgical patients at pre-existing nutritional risk. The focus of this guideline is particularly on the nutritional aspects of the ERAS concept (Plan A). This relates preoperatively to strategies for conditioning ("prehabilitation"). Postoperatively, despite the best possible care, severe complications may occur with the need for reoperation and intensive therapy, requiring special nutritional therapy, including medical (artificial) nutrition (Plan B).From a metabolic and nutritional perspective, the following aspects are central to perioperative care:Integration of nutrition into the overall perioperative management of the patient.Avoidance of prolonged perioperative fasting periodsResumption of oral nutrition as early as possible after surgical interventionsEarly start of nutrition therapy in patients at metabolic riskMetabolic control, e. g., of blood glucoseReduction of factors that induce stress and catabolism or impair gastrointestinal functionRestrained administration of drugs with unfavorable influence on intestinal peristalsisEarly mobilization to stimulate protein synthesis and muscle functionThis guideline presents overall recommendations for daily clinical practice