Are your patients missing out on nutritional optimization?

Leila Hammond, Registered Dietitian, MHSc

What's inside:

  • What is nutritional optimization? 
  • Can surgical outcomes be influenced by nutrition? 
  • Protein supplementation improving surgical outcomes 
  • Preoperative carbohydrates for metabolic stress 
  • How to implement nutrition optimization in practice 

Nutrition is an important, yet often overlooked component of surgery. Did you know that optimizing patients through nutrition can help mitigate the risks of surgery, improve outcomes and promote recovery? 

Orthopedic surgery puts significant stress on your patients’ bodies, which can impede recovery. While there are several medical interventions that are used to minimize this stress, nutrition is a high-impact, low-risk intervention that is often under-utilized. The right nutrition in the perioperative period can lead to a better surgical recovery.  ERAS (Enhanced Recovery After Surgery) guidelines highlight a peri-operative care standard that is designed to lead to a better and earlier recovery and emphasize the use of perioperative nutrition 1–4. 

 

What is nutritional optimization? 

Nutritional optimization refers to using nutrition to optimize patients’ metabolic state prior to surgery to improve outcomes1. Before and after surgery, orthopedic patients have alterations in metabolism that impacts the body’s ability to recover2,3; nutrition optimization improves outcomes by addressing these metabolic changes2–4. 

 

Can surgical outcomes be influenced by nutrition? 

The stress of surgery can lead to catabolism, a breakdown of the body’s tissues. These losses of body proteins result in detriments to strength, mobilization, immune function, and wound healing7–9. Surgical stress can be worsened by poor nutrition in the perioperative period and lead to worse outcomes. Poor nutrition and nutrition status in orthopedic surgery is associated with:  

  • Increased risk of surgical site infection10,11. 
  • Increased risk of readmission12  
  • Longer length of stay12 
  • Delayed mobilization13 
  • Increased risk of revision14  
  • Increased risk of overall complications13–15 
  • Increased risk of postoperative infection 14 

In the context of orthopedic surgery, two nutrients have been shown to have a benefit: protein and carbohydrate 1–3,16,17. Specifically, protein supplementation and presurgical carbohydrates are interventions that minimize catabolism in the perioperative period to preserve muscle mass and function and accelerate healing 6,17. 

 

Protein supplementation improving surgical outcomes  

In orthopedic surgery, perioperative protein and amino acid supplementation have been shown to:  

  • Improve markers of malnutrition 16,17   
  • Reduce muscle atrophy 18–21 
  • Attenuate markers of inflammation17,18 
  • Increase promoters of bone regeneration 17 
  • Reduce pain scores21 
  • Reduce disability scores21 
  • Accelerate wound healing17 

Protein is important for maintaining body tissues like muscle, rebuilding tissue injury during surgery, and maintaining healthy immune function5,7,8. Inadequate protein intake surrounding orthopedic surgery, which can impair mobility, delay wound healing, and increase the risk of surgical site infection10.  

Protein requirements double in the perioperative period from 0.8g/kg of bodyweight per day to over 1.6g/kg of bodyweight per day4,22. Most patients cannot get this amount of protein from diet alone, especially with reduced appetite as a common side effect of surgery3,23. High quality protein supplements like ISOlution can help your patients meet their elevated protein needs, to have better outcomes, and get back to what they love doing faster6.  

Protein supplements taken before and after surgery are recommended for nutrition optimization. Taking protein before surgery stimulates muscle protein synthesis, so that function is maximized in advance of the stressful event of surgery20. This is important as many of the conditions that lead to orthopedic surgery often involve inflammation, which increases the body’s protein requirements24.  This means that many of your patients are going into surgery at a protein deficit. Low levels of mobility due to injury or disease leading up to surgery exacerbates this problem as patients go into surgery with sub-optimal muscle mass, further limiting function and recovery 25,26. 

 

Preoperative carbohydrates for metabolic stress 

Preoperative carbohydrate loading in the form of complex carbohydrate drinks taken before surgery have been shown to reduce post operative insulin resistance, which the body’s natural response to stress29. The benefits of preoperative carbohydrate loading are: 

  • Reduced postoperative catabolism29,30 
  • Reduced muscle loss29,30 
  • Reduced length of hospital stay29,30 
  • Improved wound healing29–31 
  • Perioperative glucose control29,30 

Not only that, but these complex carbohydrate drinks can give your patients a better surgery experience and improve patient satisfaction by decreasing patient discomfort before and after surgery29,31,32.  

Best practice for preoperative carbohydrate loading is 800mL of a 12.5% maltodextrin carbohydrate drink taken the night before surgery and 400mL of a 12.5% maltodextrin carbohydrate drink taken 2-3 hours before surgery. Preoperative carbohydrate drinks like PREcovery help replete glycogen stores in the muscle and liver, provide hydration and reduce surgical stress. 

  

How to implement nutritional optimization in practice 

The Ortho Nutrition Bundle (ONB) was created with researchers and orthopedic surgeons to align with the principles of nutrition optimization for orthopedic surgery.  

The Ortho Nutrition Bundle consists of:  

  • 2 weeks of preoperative protein supplementation (ISOlution) to give patients the protein they need to replenish and build body proteins like muscle;  
  • A preoperative complex carbohydrate drink (PREcovery) which improves post-operative metabolism and patient experience;  
  • 2 weeks of post-operative protein supplementation to maintain muscle mass and improve surgical healing.  

The Ortho Nutrition Bundle takes the guesswork out of nutritional optimization and implements seamlessly into your practice's existing patient workflow. Get in touch with us at 1-800-619-0783 or info@emnortho.com to know more. 

 

Authored by: Leila Hammond, Registered Dietitian, MHSc. 

 

 

References:

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