per bottle) nutritional supplements like Boost or Ensure for 3 or 4
weeks before procedures to improve their nutritional status. The
drinks cost $1 to $2 a piece, so a patient might spend $30 to $40 to
take the nutritional supplements leading up to surgery. Consider writ-
ing prescriptions for the drinks so patients can submit the expenses
for reimbursement to healthcare savings plans and insurers.
Vitamin D deficiency is rampant among surgical patients. Those who
are deficient have been shown to be at 3 to 4 times the risk of post-op
infection. That's inexcusable because Vitamin D supplements (50,000
units D3 x 1 dose) can often replenish deficient levels within a week.
The duration of needed pre-op nutritional support varies in guidelines
from 7 to 14 days, but even 5 to 7 days of therapy can reduce post-op
morbidity in malnourished patients by 50%. No malnourished patient
should have surgery without nutritional optimization, but 2 out of every
3 patients who undergo GI procedures are malnourished and 43% of
malnourished patients are not identified. Malnutrition is the 4
th
leading
association of death within 30 days of surgery, according to the National
Surgical Quality Improvement Program. It's also the only one on the Top
10 list that you can address by telling patients to reach for a carb-rich
drink.
OSM
8 4 • 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 1 7
Dr. Wischmeyer (paul.wischmeyer@duke.edu) is a professor of anesthesiology
and surgery and director of nutrition support at Duke University School of
Medicine in Durham, N.C.
