the last 3 months?
• Has the patient had a poor appetite — eating less than half of his
meals or fewer than 2 meals per day?
• Is the patient unable to take food orally (dysphagia or vomiting,
for example)?
Additionally, for inpatient procedures, the checklist also suggests
testing the patient's albumin level to ensure it's not less than 3.0 g/dL.
(Historically, we have used low albumin as an indicator of malnutri-
tion, but relying on albumin levels alone may falsely diagnose
patients as malnourished.) For complex GI surgeries, the checklist
also suggests giving the patient evidence-based immune modulating
supplementation.
Optimizing nutrition before surgery
You can optimize nutrition in the 3 to 4 weeks between when the
patient is scheduled for surgery and they arrive at your facility. Once
you run through the screening process, if you determine the patient is
nutritionally at risk, then you want to work with a nutrition specialist
or dietitian to provide guidance to get the patient the proper diet in
the weeks leading up to surgery. The exact guidance to improve the
patient's condition can vary greatly, depending on the factors con-
tributing to malnourishment. Regardless, the goal is to get the patient
in the best possible shape for surgery.
Keep in mind that sometimes the patient's condition will handcuff
the amount of improvement. For example, if you have a patient with
ulcerative colitis, you may need to improve his malnourished condi-
tion before the scheduled surgery. You can likely improve it, but you
may not get the patient to 100% before surgery.
And for all patients, don't forget about the importance of nutrition in
the hours leading up to surgery. Though historically we have told
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