Ashley Ludlow
MS, RD, CSG, ACE-CHC, LDN, FAND Good Nutrition Makes a Difference
I have had four surgeries so far, one major one, and three minor ones. I am guessing that you, too, have had some type of surgery. If you haven’t had surgery yet, chances are that you will at some point in your life. Fun times. If you or your loved one is going to be having surgery, good nutrition can make a major difference in how you do. Boosting your nutrition before surgery and consuming extra calories, protein and other nutrients after surgery can help you heal faster, fight infection and get home sooner. In conventional care, it was often believed that eating before surgery was not safe. We were told not to eat or drink prior to surgery (usually nothing to eat or drink after midnight) in order to prevent issues during surgery. We also were told that we should not eat after surgery until a doctor could hear bowel sounds and/or we were able to have a bowel movement. For some people, this took days! Over the last 10 years, Enhanced Recovery After Surgery (ERAS) programs have been adopted as the standard of care across the world. These guidelines, based on research, have led to major improvements in the care and recovery of patients having scheduled surgeries, When ERAS is used successfully, people go home after surgery 35-40% faster. The nutrition component of ERAS includes goals for the three phases of the program: 1. Before surgery – Boost a patient’s nutrition status 2. During surgery - Minimize the stress response of surgery 3. After surgery – Help the patient recover as soon as possible Surgery is a major stressor to your body and your immune system. That is why it is vital to optimize your nutrition status before surgery. Surprisingly, one out of three surgery patients is at high risk of
being malnourished. That is a lot of people. Is it your grandmother? Is it your dad? Or is it you? Malnourished doesn’t mean super skinny or emaciated. In a study of cancer patients who were malnourished, 79% of them were normal weight, overweight and/or obese. Both under and over consumption can cause malnutrition. Studies show that if you are malnourished before you have surgery you have significantly worse clinical outcomes. This includes an 3x higher risk of complications such as infections, a much longer stay in the hospital, an increased risk of be readmitted to the hospital, higher hospital costs, and you have an increased risk of dying. Yikes! Now that you know why it is so important to be well nourished before, during and after surgery, how does that look? The ERAS guidelines recommend that well-nourished people receive nutrition supplementation with highcalorie, high-protein oral nutrition supplements (such as Ensure) twice a day for one to two weeks prior to surgery. If you are at risk for malnutrition, it is recommended that you drink more oral nutrition supplements (three a day), for that same time period. Right before surgery, ERAS now recommends that you no longer have to go without food or beverages for so long before surgery. The guidelines say you can consume solid food up to six hours prior to surgery and clear liquids up to 2 hours before. ERAS patients are also recommended to be given 2 special carbohydrate beverages the night before surgery and one the morning of surgery to decrease insulin resistance, decrease risk of muscle loss, and improve your comfort. After surgery, the guidelines recommend that you eat or drink as soon as you feel ready, and you no longer have to wait for bowel sounds before you eat. Eating and drinking sooner rather than later helps
... good nutrition can make a major difference ...
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