American Journal of Clinical Nutrition, Vol 3, 449-455, Copyright © 1955 by The American Society for Clinical Nutrition, Inc.

Principles of Surgical Nutrition

¹ From the Department of Surgery, The Ohio State University Health Center, Columbus, Ohio

The numerous advances in nutrition made through clinical and laboratory studies should serve as a guide to practical nutritional therapy. A basic knowledge of nutrition is important but serves little purpose if careful attention is not given to actual diet intake and weight trend. Day-to-day evaluation of weight should be as routine as the evaluation of temperature, pulse, and respiration. While emphasis has properly been placed on the problems of malnutrition, there has been a tendency to overlook the equally important factor of obesity.

Morbidity and mortality can be further lowered through the correction of obesity prior to surgery. Whereas weight reduction may not be practical prior to many operations, the time has come for surgeons to refuse strictly elective surgery until some weight reduction has been accomplished. This may best be realized through a simple diet with the evaluation of excessive eating being made and charted by the patient. The anticipation of earlier convalescence should encourage the patient to accept the necessity of weight reduction.

Correction of nutritional deficits can properly be made only through frequent evaluations of the patient's response and a plan of therapy which permits lability in the utilization of several available methods of feeding. Oral intake is preferred and most patients will receive adequate basic requirements if encouraged through changes of diet and supplemental feedings. The application of a knowledge of the protein and calorie values of common staple foods is necessary to the attainment of daily requirements. When oral methods fail, tube or intravenous feedings should be instituted. Homogenized milk offers a practical, nutritious, and readily available source for both gastric and jejunal feedings.

Since many patients with a malignancy or chronic disease cannot await weight gain before operation, the blood volume deficits in these patients must be appreciated. Blood volume deficits are somewhat related to weight loss; a 50-to 100-ml deficit per pound of lost weight has been found. Despite weight loss, these patients will tolerate surgical procedures, if blood volume deficits are corrected.