are at increased risk of
being hyperglycemic
and experiencing
insulin resistance
brought about by the
trauma of surgery, according to Elizabeth Goldenberg, MPH, RD, CDN,
a registered dietician at Weill Cornell Medicine in New York, N.Y.
"They're also more likely to have more GI symptoms and experience
PONV," says Dr. Goldenberg. She points out optimizing pre-op nutrition
puts patients in an anabolic state, during which the body builds lean
muscle mass, instead of a catabolic state, which involves the loss of
body mass.
As soon as possible after cases are scheduled (ideally 6 to 12 weeks
before surgery), Ms. Yoder spends an hour with patients to review
their medical histories, the medications and supplements they're tak-
ing, the average amount of sleep they get on a nightly basis. She asks
about their cooking habits, stress levels and home life. She then cre-
ates interventions specific to their needs to help promote weight loss
and manage existing comorbidities. "It's important to set realistic
goals for patients, so they feel motivated to change their health sta-
tus," says Ms. Yoder.
She prioritizes the care of patients with BMIs over 40 who are at
higher risk for complications during and after surgery. Her goal is to
help patients lose weight and build lean muscle mass, which helps
support the body's structure. Lowering a patient's BMI also reduces
pressure on joints and decreases the body's inflammatory response to
surgery. Patients who lead healthier lifestyles and lose weight before
surgery are better prepared to complete rehab exercises and often
require lower dosages of prescribed medications that could increase
risks of surgical complications. Some might even be able to stop tak-
7 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 0
We find the right amount
of fuel for their bodies.
Melinda Yoder, RDN, CDN