Soltalk July 2018 | Page 42

Doctor’s notes
Dr Rik Heymans is a general practitioner in Nerja and writes on developments in the world of medicine
Undernourished before surgery
When a person undergoes any form of major trauma- and
surgery is also a form of trauma - the body enters into a
condition which is called “anabolic resistance”. This means that
the production and or maintenance of muscle tissue is
reduced, which leads to loss of muscle mass and wasting. To
combat this, more intake of protein and calories is required.
This seldom occurs in any hospital anywhere in the world - as
anyone who ever has been hospitalized would know. Resulting
ultimately in the admission of these weakened patients to
rehabilitation or geriatric centres.
Far too many patients who are booked to undergo surgery
have been found to be malnourished, or undernourished. A
study which looked at this found that one of every three
patients who were admitted for elective surgery suffered from
some degree or other of malnutrition. And of these 33% very
few were screened, let alone detected. A stay afterwards in
Intensive Care would deplete the nutritional status even
further. This is considered “a silent hospital epidemia”, because
of these abovementioned reasons. How many people do you
know in your circle of family and friends who, after a lengthy
hospital admission, came out weighing several kilograms less?
An interesting Chinese study from 2012 found in patients,
scheduled for elective major abdominal surgery, that 5 to 7
days of preoperative nutritional therapy reduced
complications and illness post-operative by 50%! And a
Swedish study even cast doubt on the universally practised
pre-operative fasting, where the patients were given 50 grams
of carbohydrates 2-3 hours before their operation, resulting in
greatly improved outcomes. They drew an analogy with an
athlete who is going to run a marathon - he would not starve
himself the day before such a race… nor wait for a couple of
days after the race to start feeding himself!
A poor state of nutrition greatly affects the surgery’s outcome,
and the post operative recuperation as well - which sounds
quite obvious; it was observed that the risk of death increased
5-fold, and of major complications 3-fold. So it was felt that
patients who are about to undergo surgery should undergo a
nutritional evaluation, and be given parenteral nutrition post-
operative –especially if a stay in Intensive Care is required.
Four questions can help to identify those at risk: a Body Mass
Index below 18.5 (<20 for those older than 65 years);
unintentional weight loss of more than 10% in the last six
months; loss of appetite, and eating less than 50% of the
normal food intake in the last week; and lastly, a blood test.
© Dr RIK HEYMANS
c/ Angustias 24, Nerja.
Tel: [phone]
40