It is agreed among most clinicians that patient morbidity, mortality, and hospital length of stay can be negatively affected by malnutrition. In fact, nutrition guidelines state that any patient unable to consume adequate nutrients orally (60% nutrition needs) for at least 5 days in the critically ill, or 7 to 14 days in the general population, should be a candidate for specialized nutrition support and that enteral feeding is preferred over parenteral nutrition.1 However, inadequate attention to nutrition intervention may occur for several reasons, including lack of recognition of need for various patient populations, low priority, and controversial clinical outcomes. Because of variance in research designs where nutrition intervention may be provided to well-nourished or mildly malnourished patients and lack of stratification for comorbidities or surgical pathology, thus resulting in little to no benefit with early nutrition intervention, many clinicians opt not to aggressively feed their patients until complications arise and forgo preoperative nutrition intervention altogether.

Significantly increased postoperative complications, mortality rates, intensive care unit (ICU) and hospital length of stays were found to occur among general surgery patients that were capable of receiving preoperative nutrition but did not.2 Complications were correlated with operative site, magnitude and complexity of the procedures and preoperative albumin levels, with complications rising as albumin levels dropped (Table I). For patients with an albumin level 3.25 g/dL), all differences vanished, reflecting the high number of poorly nourished patients in the VA system and public hospitals.