In malnourished surgical patients, what is a recommended approach to improve outcomes?

• A. Preoperative nutritional optimization when feasible (enteral preferred)
• B. Postoperative nutrition only
• C. No nutrition support
• D. Parenteral nutrition only

Answer: (A)

Optimizing nutrition before surgery in malnourished patients improves their ability to withstand the stress of surgery and heal. Providing nutrition preoperatively supports the immune system, preserves wound healing, and reduces complications. If the gut is functional, enteral nutrition is preferred because it maintains the intestinal mucosa, lowers infection risk, and is safer and cheaper than parenteral nutrition. Starting nutrition before the operation is better than waiting until after. If preoperative optimization isn’t possible, use perioperative or early postoperative nutrition, but relying on parenteral nutrition alone carries higher risks and is not as favorable when enteral feeding is feasible.