More than 50% of older surgical patients are thought to have malnutrition that is associated with increased postoperative complications, prolonged length of hospitalization and increased health care cost.
The surgical patient is at a nutrition and fluid disadvantage right off the bat due to the “Nothing by Mouth” order. The patients are getting ready to “run” the big surgical race with a fuel tank on empty! The tank needs to be filled during the preoperative, optimization time by implementing a nutritional plan that is right for the individual patient.
Optimizing the patient for surgery is a well-known process that minimizes risk for postop complications. Preop x-rays, blood work, cardiac clearance, and EKGs are just a few ways the patient can be optimized before the day of surgery. Once the surgical day comes the optimization continues, no eating, no drinking (to decreasing the risk of aspiration upon intubation) and cleaning the patient with chlorhexidine wipes to decrease transient bacteria. Some surgeons are taking it a step further with an Enhanced Recovery After Surgery (ERAS) care plan that adds more interventions to the preop optimization plan to improve patient engagement, quality of recovery, and improve safety outcomes. This is where presurgical nutritional optimization can come into the plan. Nutritional status plays a central role in the process of wound healing, so it makes sense to add it to the optimization plan.
Gills (2015) reports that patients with illness, including surgical injury, inflammation, and malignant disease, often present with an elevated turnover of body proteins necessitating a greater total protein intake to attenuate the catabolism of body tissues to meet needs.
While nutritional status is often not included in the preop assessment, it can be a great tool to identify the patients that are at higher risk for pressure injuries along with clinical judgment. Once you identify a patient as high risk for perioperative skin injury, you can implement interventions like, silicone dressings and interoperative micro movements to decrease that risk. Introduction of nutritional awareness into your preop setting is a great step towards enhancing patient outcomes.
Gillis C, Carli F. Promoting perioperative metabolic and nutritional care. Anesthesiology 2015; 123: 1455–72.
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