In malnourished surgical patients, what is the 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)

In malnourished surgical patients, addressing nutritional deficits before the operation markedly improves outcomes by supporting immune function, wound healing, and overall nitrogen balance. Enteral nutrition is preferred when the gut is functional because it helps maintain gut mucosal integrity and lowers infection risk compared to parenteral feeding.

Therefore, the best approach is to optimize nutrition preoperatively when feasible, using enteral feeding if the patient can tolerate it. If the gut cannot be used, parenteral support may be considered, but it is not the first-line strategy when enteral feeding is possible. Postoperative nutrition alone or no nutrition support would not adequately address the underlying deficiency and is associated with worse outcomes.