Evaluation and management of nutritional status before surgery.

Preoperative evaluation of all patients should include evaluation of nutritional status. Factors of greatest clinical usefulness are nutritional history correlated with the clinical situation, and measures of body height and weight, serum albumin concentration, and muscle mass. Depressed immune function suggested by a lack of skin test reactivity to standard antigens may correlate with the risk of postoperative complications and death, but further studies are required to determine the specific relation of nutrient deficiencies and immune function. Micronutrient deficiencies must be identified and corrected rapidly. Nutritional support in patients with nutritional deficiencies should be started preoperatively either by enteral or intravenous techniques and continued postoperatively.