The Effects of Malnutrition and Refeeding on Perioperative Wound Complications in Surgical Patients With Eating Disorders: A Narrative Review
Abstract
Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders (EDs) with the highest mortality rate of psychiatric illnesses and medical complications, often due to protein-energy malnutrition and micronutrient deficiencies, leading to poor long-term outcomes. Patients with EDs undergo changes in nutritional status that manifest as decreased skin tensile strength, impaired immune function, reduced collagen production, and disrupted electrolyte and fluid balance, thereby increasing the risk of surgical site infections (SSIs), pressure ulcers (PUs), refeeding syndrome (RS), and edema/refeeding edema (RE). This narrative review aims to describe evidence regarding how malnutrition in patients with EDs impairs perioperative wound healing and propose clinical guidelines to reduce complications. The Web of Science, PubMed, and Scopus databases were searched using terms related to EDs and malnutrition. Peer-reviewed studies were included if they addressed malnutrition in the context of EDs, discussed compromised tissue repair, examined associations between malnutrition and perioperative outcomes, or evaluated nutritional interventions for recovery in malnourished hospital patients. Excluded were opinion pieces and writing that lacked ED wound-healing outcomes. The main findings of the 31 included studies are as follows. One, chronic malnutrition in AN and BN is associated with dermatological manifestations, such as xerosis and ecchymosis, reflecting reduced dermal strength and…
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