requires? Before admitting the patient, you should perform a nutrition
screening, says Dr. Evans. Since many outpatient procedures are
"lower-risk operations, there's probably not as much of a nutritional
assessment intervention required" as with typical inpatient surgeries,
says Dr. Evans. But as a growing number of outpatient centers are
performing more complex procedures, a more rigorous pre-op nutri-
tional assessment is more important in those cases. However, Dr.
Evans stresses that nutrition screening should always be employed
for "risk stratification, to decide who is appropriate for the ambulato-
ry setting."
Patients who display undernutrition should be of particular concern,
he says, but often such patients are waved through when maybe they
shouldn't be, because they don't seem otherwise unhealthy.
"Sometimes you may have someone who doesn't have the typical
comorbidities that would flag them for ASA IIIs and IVs, but on a
nutrition assessment — if you're looking at recent weight loss, or BMI
less than 18.5 — if they meet one of those triggers, then they probably
have some unrecognized nutritional risk," notes Dr. Evans. Another
screening test, he says, can involve measuring serum albumin levels,
with less than a 2.0 measure of the vital protein as a cutoff.
If those findings or others result in a diagnosis of undernutrition, Dr.
Evans advises getting a dietitian involved. At the very least, he says,
explore ways to optimize the patient's nutritional status before surgery.
Carb-loading
Patients with low BMI or recent weight loss should start supplement-
ing protein and optimizing nutrition a month or more before surgery
or, alternatively, surgery should be delayed until they can complete
such a regimen, says Dr. Evans. When supplementing protein, he
adds, "you may want to combine that with an exercise regimen,
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