Feeding and Postoperative Nutritional Support
Postoperative osteotomy and fracture patients are often neglected from a nutritional point of view, despite obvious eating and drinking difficulties, pain and orofacial swelling. Malnutrition is a well-recognised problem in hospitals, with 40%-50% of all patients found to be malnourished on admission and 70%-80% on discharge. Although the former statistic is unlikely to apply to orthognathic patients the latter is often the case.
This patient group are by the nature of their surgery at risk of malnutrition owing to raised nutritional requirements and impaired nutritional intake. Consequences of malnutrition for the postoperative patient include decreased wound healing, decreased immune function and increased infection risk which can lead to unnecessary morbidity. Establishing and maintaining adequate intake should be seen as a priority. Patients with inadequate oral intake post-surgery or those requiring modified texture diets on discharge from hospital, should be referred to a dietician for individualised nutritional assessment and advice. Energy and protein requirements vary according to a patient’s age and gender, and individualised nutritional assessment ensures optimum daily requirements are highlighted and achieved.
Optimum Daily Requirements
- Men and women average 2000-3000 kcal.
- 0.8 g protein/kg; 65-1000 g protein.
- 2-3 litres fluid.
Immediate Postoperative Feeding
1. 0-24 Hours Post-Operation: Intravenous Fluids
Having replaced blood loss to within 500 ml, compound sodium lactate (Hartmann’s) solution is given to balance vomited fluid, gastric aspirate, urinary output and metabolic needs. The volume will be 2 to 3 litres depending on the patient’s weight and the ambient temperature. The patient should also be encouraged to drink a little.
2. After 24 Hours
If the patient is well, and the surgical procedure allows, trials of oral fluid should be commenced using a feeding cup, straw or a large bore syringe and quill. Most orthognathic cases can cope, but if oral intake is proving difficult, enteral feeding should be commenced using a fine bore nasogastric feeding tube. This should be carried out under dietetic supervision to ensure the appropriate calorie />