Optimizing Surgical Outcomes With Perioperative Nutrition

The most common reasons for readmission to the hospital within 30 days of discharge from a surgical procedure are gastrointestinal complications, surgical infections, and malnutrition. Perioperative nutrition interventions can help optimize a patient’s overall nutritional status before, during, and after surgery, which not only reduces the patient’s risk for postoperative complications, but also improves the patient’s outcome and overall quality of life.

“Perioperative nutrition encompasses preoperative (before surgery), intraoperative (during surgery), and postoperative (after surgery) care,” explains Krystle Zuniga, PhD, RD, LD. “During and after surgery, there are hormones and other inflammatory signals being released from your body that impact how your body metabolizes nutrients, resulting in an increased demand for energy, protein, and other nutrients. An increase in stress hormones also suppresses your immune system, putting you at higher risk for infection and rehospitalization. I tell my patients that when they undergo surgery, their body is basically running a marathon on the inside. While patients may think they’re just laying around and resting during the recovery process, there’s a lot going on inside the body that is affecting their nutrition status.”

A relationship exists between diet and exercise in which your diet impacts your body’s physical performance. Just as you would want to condition yourself physically prior to taking on a marathon, you also want to address your nutritional needs to ensure you are able to support your physical goals. In addition to carrying out physical rehabilitation post-surgery, prehabilitation (getting into pre-surgery shape) can help build up your body’s strength prior to surgery and lead to an earlier surgical recovery. Addressing nutritional support pre- and post-surgery can also help support muscle quality and muscle function, which often deteriorates quickly in the post-surgery period.

Effects of surgery on the body include:

• Altered metabolism
• Functional decline
• Impaired immune function
• Muscle loss

The Role of Nutrition

“Food is more than just fuel,” says Dr. Zuniga. “Food provides micro- and macronutrients that serve as building blocks for every cell in the body and supply essential nutrients to support essential functions. When you undergo a surgical operation, your body perceives that operation as an injury, and it’s important to supply your body with the right nutrients pre- and post-surgery to support healing and recovery. Essentially, we want to build up that nutritional reserve in a way that will optimize immune function and lower the risk for complications.”

Poor nutritional status can:

• Delay wound healing
• Slow the body’s ability to recover
• Impair immune function
• Increase the length of hospitalization
• Interfere with the function of the heart, liver, and kidneys
• Reduce physical function

“ERAS, or enhanced recovery after surgery, is a set of evidence-based clinical guidelines associated with different types of surgery that have been researched and shown to promote better outcomes. These guidelines have been designed to standardize and optimize perioperative medical care. The importance of nutrition in both the pre- and post-surgery period is discussed throughout the guidelines,” explains Dr. Zuniga.

Preparing for Surgery

“Even short-term nutrition interventions improve outcomes,” says Dr. Zuniga. “Working with a dietitian, even in the short-term, can help reduce your risk for rehospitalization and infection as well as help you experience an earlier return to baseline function.”

A pre-surgical nutrition intervention includes a comprehensive nutrition assessment prepared by a registered dietitian, who considers a patient’s medical history, surgical procedure, and medications prior to developing a strategy that will not only help the patient prepare for and recover from surgery, but also empower the patient to be an active member of their own healing and recovery process.

“Smoking and alcohol consumption are common risk factors for developing complications during and after surgery. Smoking causes blood vessels to contract, which restricts the amount of blood flow to vital organs and prolongs the healing process, and alcohol is a diuretic, meaning it removes fluids from your blood, which leads to dehydration. Alcohol also weakens the immune system and prevents blood cells from being able to clot properly, putting you at increased risk for excessive bleeding both during and after your surgery. Reducing tobacco use and eliminating alcohol reduces your risk for these complications,” explains Dr. Zuniga.

Your gut health also plays a major role in supporting your immune system. Ensuring your body has access to adequate fiber, hydration, and physical activity can promote good gut health and help with strengthening your immune system.

Surgery and Anxiety

“A patient’s anxiety around surgery can also impact their stress levels,” reveals Dr. Zuniga. “There is some really interesting research on the association between preoperative anxiety and increased anesthetic requirements, increased pain, increased risk of infection, and slower postoperative recovery. Mind-body interventions, such as guided meditation, or music therapy have been shown to have a beneficial effect on preoperative anxiety.”

Guided meditation and breathing mobile apps and websites:

• Breathe2Relax
• Calm
• Guided Meditations
• Happify
• Headspace

Surgical Recovery

As we learn more about the importance of nutrition in relation to patient outcomes, some of the more traditional surgical protocols that delayed or limited nutrition after surgery are beginning to change.

The body requires extra nutrients to heal. Nutrition deficiencies after surgery can delay the recovery process and reduce your chances for an optimal recovery. Good nutrition after surgery can promote wound healing and support immune function.

“Unfortunately, IV fluids and clear liquids aren’t going to cut it,” says Dr. Zuniga, “These types of protocols have been done to minimize risks of complications, but being too conservative has risks, too. Malnutrition and underfeeding promote inflammation and muscle wasting, and gut starvation decreases immune function.”

Surgery is a stressful experience for the body, and surgical stress can cause post-surgery complications, such as an increase in blood sugar levels (in which case you may not have diabetes but now all of a sudden are experiencing some trouble with your blood glucose levels). Increasing your protein intake and reducing added sugar in combination with physical activity (as tolerated) can help prevent delays in your ability to return to the activities you were carrying out before.

Recovering at Home

After surgery, you may experience some mobility issues that could make it more difficult to grocery shop or prepare foods at home. Try to prepare some easy meals and snacks ahead of time for when you return home after your operation. You will likely experience changes in appetite as well, so it’s important when choosing foods to think about eating nutritious foods during recovery and getting the most nutritional bang per bite. Choose high protein and nutrient dense foods that are easy to digest and avoid high-fat, greasy, or spicy foods.

“Pain medications, less physical activity, changes in your diet, and stress can slow the digestive system, and people may experience a change in their bowel movements. When you eat, take a moment to clear distractions and practice deep breathing. Stress interferes with digestion and practicing diaphragmatic breathing calms the mind and promotes a ‘rest and digest” response,” explains Dr. Zuniga.

Post-surgery, patients may struggle with side effects, fatigue, pain, and depending on the extent of the surgery, it can also be a stressful experience having to readjust to a new way of life. It’s important to remember to focus on the things that you can control, such as your diet, that will support your recovery.

Depending on your specific healthcare needs, a dietitian may be a part of your healthcare journey at UT Health Austin.

You can make an appointment with UT Health Austin by calling 1-833-UT-CARES (1-833-882-2737) or by visiting online here.