Perioperative Nutrition

Perioperative Nutrition

DCRI Perioperative Nutrition focuses on the study of hospital-based treatments to improve preparation and recovery from surgery, major illness, and critical care. Perioperative nutrition puts real science into how we improve patients' lives with interventions such as nutrition and exercise.

This work includes NIH and privately funded research that investigates the role of nutrition, exercise, the microbiome, probiotics, and other nutrition-related interventions such as protein delivery and sports nutrition to improve outcome and quality of life following acute/chronic illnesses.

Passion for Care

DCRI Perioperative Nutrition is led by Paul Wischmeyer, MD, whose passion for helping patients recover from illness and surgery arises from his personal experiences as both a doctor and a patient in the ICU. Wischmeyer, who has undergone more than 20 major surgeries, has personally experienced multiple ICU stays due to a childhood GI illness that took more than half of his intestinal tract. As a result, preparation for surgery/critical care and recovery from illness fuel Wischmeyer's dedication to teaching patients and caregivers worldwide.

Research Highlights

Perioperative Use of Arginine-supplemented Diets: A Systematic Review of the Evidence


This article provides an up-to-date review on all studies of arginine-supplemented diets in elective surgical patients. Using a larger database, the authors shed light on the perioperative role of such

Critical but overlooked: ICU patients’ gut bacteria


In pursuit of restorative treatments, researchers are examining changes to the microbiomes of critically ill patients.

Assessment of perioperative nutrition practices and attitudes—A national survey of colorectal and GI surgical oncology programs


Data suggest surgeons recognize both the importance of proper perioperative surgical nutritional support and the potential value to their patient's outcomes but fail to implement evidence-based nutrition practices.

Key Facts on Perioperative Malnutrition and Nutrition Therapy


Paul Wischmeyer, MD, shares some striking information on perioperative malnutrition and nutrition therapy from a recently published survey on surgical nutrition.

-Williams JD,
Wischmeyer PE. Assessment of Perioperative Nutrition Practices and Attitudes—A National Survey of Colorectal and GI Surgical Oncology Programs. Accepted, American Journal of Surgery, 2016. PMID: 27889271
-Awad, S and Lobo, D. What’s new in perioperative nutritional support?
Current opinion in anaesthesiology 24(3):339-48, 2011
Philipson et al. American Journal of Managed Care 19:121-128, 2013

Paul Wischmeyer, MD
Director, Perioperative Nutrition

“Everyone talks about improving patient care….but it’s time to start doing it."
Paul Wischmeyer

Is Your Hospital Screening for Malnutrition and Coding for it?

Research shows physicians who screened patients for malnutrition and treated it prior to the procedure had better patient outcomes. Only five days of intervention can lead to better nourishment and fewer complications from surgery.

Malnourished patients require longer hospitalizations which are more costly. Hospitals must screen and code for malnutrition in order to receive appropriate reimbursements.


Perioperative Screening Clinic

The Duke Perioperative Screening Clinic is designed exclusively to assess patients before surgery.

By performing a nutritional evaluation prior to surgical a procedure, physicians and patients can get a better understanding of patient readiness and develop a plan for good post surgical care.

Select Publications

Oshima T, Deutz NE, Doig G, Wischmeyer PE, Pichard C. Protein-energy nutrition in the ICU is the power couple: A hypothesis forming analysis. Clin Nutr. pii: S0261-5614(15)00270-8, 2015 PMID: 26608526

Preiser JC, van Zanten A, Berger M, Biolo G, Casaer M, Doig G, Griffiths R, Heyland D, Hiesmayr M, Iapichino G, Laviano A, Pichard C, Singer P, Van den Berghe G, Wernerman J, Wischmeyer PE, Vincent JL Metabolic and nutritional support of critically ill patients: consensus and controversies. Critical Care, 19:35, 2015 PMID: 25886997

Ziegler, TR, May AK, Hebbar, G, Easley, KA, Griffith DP, Collier BR , Cotsonis GA, Hao L, Leong T, Manatunga AK, Rosenberg ES, Jones DP, Martin GS, Jensen GL, Sax HC, Kudsk KA, Galloway JR, Blumberg, HM, Evans ME, Wischmeyer PE. Efficacy and Safety of Glutamine-Supplemented Parenteral Nutrition in Surgical ICU Patients: An American Multicenter Randomized Controlled Trial. Ann Surg. Apr;263(4):646-55, 2016.PMID: 26501700

Wischmeyer PE, McDonald D, Knight R. Microbiome and Probiotic Therapy in Critical Care. Curr Opin Crit Care. Aug;22(4):347-53, 2016 PMID: 27327243

Wischmeyer PE. Are we Creating Surviviors or Victims in the ICU? Delivering targeted nutrition to improve outcomes. Curr Opin Crit Care. Aug;22(4):279-84, 2016 PMID: 27327244

Manzanares W, Lemieux M, Langlois P, Wischmeyer PE. Probiotic and Synbiotic Therapy in Critical Illness: A Systematic Review and Meta-Analysis. Critical Care, 19:262, 2016. PMID: 27538711

McDonald D, Ackermann G, Khailova L, Baird C, Heyland D, Kozar R, Lemieux M, Derenski K, King J, Vis-Kampen C, Knight R, Wischmeyer PE. The Extreme Dysbiosis of the Microbiome in Critical Illness. mSphere, 31;1(4). pii: e00199-16.2016, PMID: 27602409

Williams JD, Wischmeyer PE. Assessment of Perioperative Nutrition Practices and Attitudes—A National Survey of Colorectal and GI Surgical Oncology Programs. Accepted, American Journal of Surgery, 2016. PMID: 27889271

Morrow LE, Wischmeyer P. Blurred Lines: Dysbiosis and Probiotics in the Intensive Care Unit. Chest. Oct 19. pii: S0012-3692(16)60775-4., 2016. PMID: 27771302

Recent Presentations

Dr. Wischmeyer addresses attendees at The International Society for Intensive Care and Emergency Medicine (ISICEM), Brussels, Belgium, March 21–24, for his plenary session talk, The Microbiome in Critical Illness, one of his many presentations at the conference.


Can We Change the Future By Optimizing Nutrition in the ICU?

Paul Wischmeyer, MD shares data on improving quality of life for ICU patients through perioperative interventions.


Paul Wischmeyer, MD, EDIC
Professor of Anesthesiology and Surgery
Associate Vice Chair for Clinical Research, Dept. of Anesthesiology
Director of Perioperative Research, Duke Clinical Research Institute
Co-Director, Nutrition Support Service, Duke University Hospital



Timothy Miller, MB, ChB, FRCA
Associate Professor of Anesthesiology
Chief, Division of General, Vascular and Transplant Anesthesia
Director, Perioperative Medicine Fellowship,
Duke University Health System