The first Geriatric Surgery Society Singapore meeting was held on 25th Jan 2018. George Toh, Senior Dietitian of Khoo Teck Puat Hospital, was invited to conduct a sharing session on perioperative nutrition care for elderly. Below are the key points shared during the session:

Malnutrition is a well-known risk factor associated with poor surgical outcomes. Due to various physiological changes related to aging, elderlies are more prone to be malnourished resulting in a higher risk of developing complications after surgery. Based on our hospital’s patient profile, every three of five elderly patients (60%) who underwent elective gastrointestinal surgeries, predominantly colorectal surgery, were found to be malnourished prior to surgery. This finding highlights the importance of nutritional screening and assessment in elderly patients prior to any elective gastrointestinal surgeries.

The malnutrition related complications however can potentially be attenuated by a period of 7-14 days of pre-operative nutritional therapy for patients with severe nutritional risk. If necessary, formula enriched with immunonutrients could be considered in malnourished patients undergoing major cancer surgery, however it should be given peri- or at least post-operatively.

Speakers for the 1st Academic Meeting (From left) : A/Prof Tan Kok Yang, Dr Pauleon Tan, Mr George Toh

 

In addition, to reduce insulin resistance and to improve wellbeing and possibly faster recovery, overnight fasting should be avoided. Pre-operative carbohydrate drinks should be considered for patients undergoing major abdominal surgery.

Post-operatively, early oral food intake is not associated with increased anastomotic leak, but has been shown to be safe and nutrition intake should be resumed as soon as possible. Protein and energy-enriched oral nutrition supplement could be used to increase energy and protein consumption for patients.

Enhanced recovery after surgery, a multimodal peri-operative care pathway designed to minimize stress and achieve early return of function, has been shown to be safe and feasible in elderly patients.

 

Reference:

Forsmo H.M., Erichsen C., Radal A., et al. Enhanced Recovery After Colorecal Surgery (ERAS) in Elderly. Gerontology & Geriatric Medicine. 2017; 3:1-8.

Weimann A, Braga M, Carli F, Higashiguchi T, Hubner M, Klek S, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr 2017;36(3):623-50.