M A R C H 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 4 9
ting, and has been linked to downstream improvement and outcomes.
"Now, we can't say, 'Okay, eat some pasta 2 hours before surgery'
because of the aspiration risk," he notes. But a moderate amount of
nutritious clear liquids will do the trick. Multiple manufacturers offer
complex carbohydrate drinks that are like liquid starch, containing
formulae of vitamins, minerals, electrolytes, sugars, amino and Omega
3 fatty acids, and more. Dr. Evans says studies have shown that carb-
loading strategies where the patient is given one dose of a drink 8
hours before surgery and another dose 2 hours before surgery work
well. Most patients who consume these drinks are still able to empty
their stomachs adequately before surgery. Bonus: The patient isn't
starving and dehydrated — and thus probably not as cranky, moody
or anxious — going into surgery.
Dr. Evans notes, however, that these drinks can be expensive and
that insurers "generally" don't pay for them. He says many inpatient
hospitals are paying for the drinks out of their own budgets and giving
them to patients at no cost.
From fasting to fed
Pre-op nutrition promotes quicker bowel recovery and hospital dis-
charge, and improves surgical outcomes, immune function and wound
healing, Dr. Evans's co-authored study found, by promoting "attenua-
tion of the metabolic response to stress." It's also widely claimed that
• It's not just for major surgery. You might think pre-op nutri-
tion programs for same-day surgeries are overkill. Not so, says
UPMC ERP co-director Stephen Esper, MD, MBA. "The concepts
are the same for every surgical patient," he explains. "You want
them to be comfortable. You want them drinking, eating and
ambulating when they go home." — Joe Paone
