Dr. Collier says optimized nutrition regimens should involve a high-
protein diet, which includes eating between 1.0 g and 1.5 g of protein
per kilo per day (an average-sized person weighing 70 kg should eat
about 100 g of protein). He gives his patients more practical advice:
Eat 3 scrambled eggs for breakfast, a protein shake during the day
and a palm-sized piece of chicken, meat or fish at dinner. They're also
instructed to eat fewer carbs and more vegetables than fruit.
A growing movement
Much of the evidence that supports carbohydrate loading and avoiding
pre-op fasting is based on major open colorectal surgery, says Dr.
Nelson. He points out, however, that the nutritional status of patients
undergoing outpatient procedures should be optimized as much as pos-
sible, especially as more involved surgeries move to the ambulatory set-
ting.
"Patients in the same-day setting can still benefit from efforts to
optimize their diet, even though outpatient procedures might not be
as complex as major inpatient procedures," explains Dr. Nelson.
Understanding the importance of optimizing patients' pre-op nutri-
tional status is increasing as more facilities implement Enhanced
Recovery After Surgery (ERAS) protocols and manage entire episodes
of care as part of bundled payment agreements. "Dietary interventions
before elective surgery should be part of a formal prehabilitation pro-
gram that focuses on nutrition, exercise and mental health," says Dr.
Nelson.
Dr. Collier hopes more surgeons focus on preparing patients for sur-
geries instead of trying to fill open spots in a schedule, especially if a
patient hasn't had adequate time to prehab for the procedure. Surgeon
convenience, he says, should never trump getting patients into a bet-
ter state of healing.
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