Title : Perioperative nutritional optimisation within enhanced recovery pathways: Impact on postoperative morbidity and length of stay following elective abdominal surgery
Abstract:
Background: Enhanced Recovery After Surgery (ERAS) pathways emphasise early feeding and mobilisation to improve postoperative recovery; however, perioperative protein optimisation remains inconsistently implemented despite its potential impact on outcomes.
Objective: To evaluate the influence of perioperative protein supplementation on length of hospital stay and postoperative complication rates in patients undergoing elective abdominal surgery.
Methods: This observational cohort study included a total of 265 adult patients undergoing elective abdominal surgery and categorized into protein supplementation (n=132) and nonsupplementation (n=133) groups. Patients in the supplementation group received a highprotein oral nutritional formula targeting approximately 1.2–1.5 g/kg/day, initiated 5–7 days preoperatively where feasible and continued for at least five postoperative days or until discharge. Postoperative complications, wound healing status, and length of hospital stay were compared.
Results: Patients receiving protein supplementation had a significantly shorter hospital stay compared with those without supplementation (4.8 ± 1.9 vs. 6.2 ± 2.4 days, p=0.001). Overall postoperative complications were lower in the supplementation group (18.2% vs. 33.8%, p=0.004). Infectious complications were also reduced (9.8% vs. 20.3%, p=0.018), including surgical site infections (5.3% vs. 12.0%, p=0.047). Optimal wound healing by postoperative day three was more frequent among supplemented patients (84.9% vs. 63.1%, p<0.001).
Conclusion: Perioperative protein supplementation was associated with shorter hospital stays, fewer postoperative complications, and improved early wound healing among patients undergoing elective abdominal surgery. Incorporating structured perioperative nutritional optimization into ERAS pathways may represent a practical strategy to improve surgical recovery.
