Miao He,1– 3 Yuanzhu Long,2 Rong Peng,4 Pinglin He,5 Yue Luo,6 Yan Zhang,6 Weiwei Wang,7 Xiaoqian Yu,8 Lei Deng,1,9 Zhaoqiong Zhu2,3 

1Department of Anesthesiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, People’s Republic of China; 2Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, People’s Republic of China; 3Suzhou Medical College of Soochow University, Suzhou, Jiangsu, People’s Republic of China; 4Department of Clinical Nutrition, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, People’s Republic of China; 5Department of Urological Surgery, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, People’s Republic of China; 6Nursing School of Zunyi Medical University, Zunyi, Guizhou, People’s Republic of China; 7Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium; 8Department of Painology, West China Hospital of Sichuan University, Chengdu, Sichuan, People’s Republic of China; 9School of Public Administration, Southwest Minzu University, Chengdu, Sichuan, People’s Republic of China

Correspondence: Lei Deng, Department of Anesthesiology, Affiliated Hospital of Chengdu University, No. 82, North Second Section 2nd Ring Road, Jinniu District, Chengdu, Sichuan, 610081, People’s Republic of China, Tel +86-13666278563, Email denglei@cdu.edu.cn Zhaoqiong Zhu, Department of Anesthesiology, Affiliated Hospital of Zunyi Medical University, 149, Da Lian Road, Zunyi, Hui Chuan District, 563003, People’s Republic of China, Tel +86-13035529980, Email zhuzhaoqiong@zmu.edu.cn

Abstract: Current perioperative nutrition management is discouraging due to the under-recognition of clinical nutrition and the lagging development of clinical nutriology. This review aimed to identify and explore epidemiology, related adverse outcomes, controversies, and dilemmas of perioperative nutritional risk/malnutrition to call for further development of perioperative nutritional medicine. Databases including PubMed, Embase, Cochrane Library, Wanfang Database, China National Knowledge Infrastructure, China Biology Medicine disc, and Chongqing VIP Database were searched for articles published between January 1, 2014 and August 31, 2024 using the following MeSH terms: (“nutritional risk”[Title/Abstract] OR “malnutrition”[Title/Abstract] OR “undernutrition”[Title/Abstract]) AND (“surgery”[Title/Abstract] OR “surgical”[Title/Abstract] OR “operative”[Title/Abstract] OR “operation”[Title/Abstract]). The incidence of nutritional risk was in the 20% range in patients undergoing elective surgery, 54% in older adults, 44– 70% in patients with tumors or major elective surgeries, and 50– 55% in children. The incidence of malnutrition ranged from 11– 77% in surgical patients. Nutrition-related perioperative adverse events included mainly infection, wound healing disorders, reoperation and unplanned readmission, prolonged hospital stay, mortality, perioperative neurocognitive dysfunction, and venous thrombosis. Current controversies and dilemmas in this field include the low rates of nutrition screening and medical nutrition therapy, numerous nutrition screening tools and malnutrition diagnostic criteria, no consensus on optimal assessment method, low level of evidence-based clinical nutrition research and lack of in-depth mechanistic studies, inconsistent timing of nutrition assessment, lack of reports for community hospitals, small hospitals, and low/middle-income countries or regions, and under-recognition of micronutrient malnutrition. It is, therefore, necessary for perioperative patients to undergo nutritional screening at the first outpatient visit before surgery and/or on admission. Perioperative nutritional management needs urgent attention and requires a multidisciplinary team, including anesthesia, nursing, nutrition, and surgery.
Plain Language Summary: Proper nutrition around the time of surgery is a crucial aspect of patient care and contributes to enhanced recovery and lower rates of complications.Nutritional risk/malnutrition remains under-recognized and untreated in perioperative patients worldwide, especially in lower-income regions.We reviewed 10 years of medical literature to assess the causes and challenges to proper nutrition for patients undergoing surgery. We found that older adults, children, and those with other medical conditions or in poverty were at the most risk.The incidence of nutritional risk was in the 20% range in patients undergoing elective surgery, 54% in older adults, 44– 70% in patients with tumors or major elective surgeries, and 50– 55% in children. The incidence of malnutrition ranged from 11– 77% in surgical patients.
We provide targeted suggestions for improving nutrition for those undergoing surgery, including better screening, improved studies and trials, a team medical approach, better documentation, and addressing vitamin and mineral deficiencies.

Keywords: perioperative nutrition, medical quality and safety, nutritional risk, preoperative risk factors, adverse outcomes