Melissa Juried Kriebel
Malnutrition is a risk factor for complications after surgery and affects approximately 25% of outpatients.
Poor nutritional status can markedly reduce wound healing and tissue repair and lead to decreased immunity and inability to tolerate and overcome stressors, such as infections, researchers from University Magna Grecia, Italy, write in their review paper published in Nutrients.
The consequences of this status include increased rates of granulomas, hypertrophic scars and keloids, seroma, and infections, particularly among obese and underweight patients.
“Patients with obesity/sarcopenia have worse surgical outcomes and pay a higher cost than patients with a normal nutritional status,” the Italian researchers comment.
“Aesthetic medical professionals and surgeons in the sector should refer to a nutritionist to ensure their patient has an adequate dietary intake and to diagnose obesity or malnutrition before any procedures.”
While clinicians recognise the fundamental role of nutritional status in surgical outcomes, health strategies based on dietary patterns for high risk populations “still need to be developed”, the authors write.
In the current review, over 500 articles were reviewed to examine the nutritional deficits or excesses associated with major post-surgical complications, including aesthetic procedures, and suggest actions for medical professions to reduce the risks for patients.
Findings suggest nutritional deficiencies have a significant role to play in negative outcomes.
The authors note that 0.1-1% of patients undergoing filler injections developed granulomatous within 24 months; 10 to 20% suffered from local complications associated with abdominoplasty; and up to 35% reported infections after breast reconstruction.
“Hematoma, seroma formation, nerve damage leading to sensory or motor loss, infection, scarring, blood loss and, in some cases, pulmonary embolism are the most frequent complications of aesthetic procedures which can also occur in any surgery.”
High risk profile
Obesity and malnutrition are both linked to increased post-operative infections. In addition, overweight patients are more susceptible to fatal complications following surgery.
Meanwhile, skin conditions that can hamper recovery are often “an expression of” eating disorders – characterised by starvation, vomiting, or drug abuse (laxatives and diuretics).
“Low consumption of fruits and vegetables leads to a deficiency of certain micronutrients that are beneficial for the skin, which include vitamins or other molecules with antioxidant properties,” they write.
“It is possible that individuals with the conditions described above could develop some complications following aesthetic procedures.”
Furthermore, malnutrition alters immune responses by decreasing T cell response, impairs phagocytic functions, and alters cytokine and antibody production, while “a variety of lesions that complicate operations are the result of nutritional disturbances”, they add.
Recommending dietary patterns with high nutritional quality, such as the Mediterranean Diet (MD) and Dietary Approaches to Stop Hypertension (DASH), would improve overall nutritional intake and reduce complications in the most vulnerable population groups, the authors maintain.
Equally, the “bundle approach” that advocates multidisciplinary communication and teamwork to develop safe and reliable care plans – using screening questionnaires and flow-charts, for example – may improve patient outcomes.
“Early coordinated actions by surgical and dietary departments can provide optimal nutritional care to pre-surgical patients,” they authors say.
“We suggest the use of a pre-operative bundle approach to prevent complications and that patients with remediable peri-operative risk factors are enrolled in a training program, which will assist in improving outcomes, lowering costs, and reducing the length of stay.”
Published online, January 10, 2023: http://doi.org/10.3390/nu15020352
“Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results”
Authors: Tiziana Vitagliano, Pietro Garieri, Lidia Lascala, Yvelise Ferro, Patrizia Doldo, Roberta Pujia, Arturo Pujia, Tiziana Montalcini, Manfredi Greco and Elisa Mazza