Perioperative Nutrition - A Nationwide Web-Based Survey of German Surgery Departments

Background: Insufficient nutrition in surgical patients increases perioperative morbidity, mortality, length of stay and therapy costs. Therefore, guidelines declare the integration of nutrition into the overall management as one of the key aspects of perioperative care. This study was conducted to evaluate the current clinical practice of clinical nutrition in surgical departments in Germany. Methods: In 2009 German Surgical Society (DGCH) members in leading positions were surveyed with a standardised online questionnaire concerning their perioperative nutritional routines in elective surgery. Results: From the addressed physicians n = 156 (6.24%) answered. Of those, 86.9% consider the nutritional status of their patients. Only 6% use standardised nutritional screening tools. Short preoperative fasting for solid and liquid food is practiced by 65% and 40%, respectively. After the operation, 65% allow intake of clear fluids on the day of surgery and 78% initiate solid food on the day of surgery or the first postoperative day. Oral nutritional supplements are given only "sometimes" or "rarely" by 53.9% of the respondents. Conclusion: The low response rate may imply the dilemma that the evidence-based benefit of perioperative nutrition does not meet sufficient interest. Even in case of a positive selection of "pro-nutrition respondents", standardised preoperative malnutrition screening is also rare. Aspects such as shorter perioperative fasting are already practiced more progressively. However, still greater efforts are needed to promote guideline- based clinical nutrition in surgical care in Germany.