The Role of Preoperative Parenteral Nutrition
Round 1
Reviewer 1 Report
i greatly appreciate the opportunity to review this manuscript which brings clarity to a persistent issue in the nutritional management of a surgery patient mostly base on older evidence. Since the literature review went back 30 years it is acceptable to see variations in patient nutritional status and parameters to assess for malnutrition. Overall, the evidence from the narrative review along with the references support the approach to preoperative parenteral nutrition recommended by the authors. i have only a few suggestions for the authors to consider
- Since LOS is influenced by the treatment itself how would you recommend that measure be used to assess outcomes of PN in preoperative patients to eliminate it as a confounder?
- page 8 line 173 - the new GLIM recommendations for malnutrition assessment place albumin in a secondary role. Albumin was discussed in the limitations - should there be a more detailed discussion of albumin's worth as a nutrition marker?
- page 9 line 234 - there is no reference or evidence in the paper to support this statement
- Future directions - since Patient Reported Outcomes are becoming of interest and these provide subjective and objective measures of quality of life and patient functional status; parameters that are likely to be influenced by nutrition therapy, would this be of interest to include as a future direction to provide a more comprehensive assessment of total patient outcomes for surgery?
Author Response
Please see the attachment.
Author Response File: 
Author Response.doc
Reviewer 2 Report
The paper is a narrative review of a well-known subject and does not provide any new information on the topic. As a matter of fact, ESPEN guidelines points that 10 days of preoperative parenteral nutrition improves post-operative outcome in patients with severe undernutrition who cannot be adequately orally or enterally fed. Conversely, its use in well-nourished or mildly undernourished patients is associated with either no benefit or with increased morbidity (ESPEN Guidelines on Parenteral Nutrition: surgery. Available from: https://www.researchgate.net/publication/26235724_ESPEN_Guidelines_on_Parenteral_Nutrition_surgery [accessed Apr 18 2020].
Beside this general comment, it is unclear that having found 4 systematic reviews an meta-analysis in the search, the total number of papers is 16(!!), unless papers included in those systematic reviews were excluded from the review. Such aspect was nor specified in the text n the results section, but they were commented in this section. The correct way should have been to add the new papers not included in the previous systematic reviews and perform a new one with meta-analysis if feasible.
It seems to be a primary research to stablish the foundations for a Clinical Trial on the use on preoperative PN at home, as written in 3.6 section. This should have been used of internal purposes and not for publishing.
Author Response
Please see the attachment.
Author Response File: Author Response.doc
Round 2
Reviewer 2 Report
The authors have correctly answeres my previous major comments. I appreciate their well-addresed and polite answers.
