Nutrition

Malnutrition is present in approximately 45% of patients at time of admission to hospital. It is often underrecognized and is associated with increased postoperative complications and in-hospital and 30-day mortality. Nutrition risk is also associated with increased length of stay, readmission, and hospital costs. (1-5) Preoperative & early postoperative nutritional intervention are associated with improvements in postoperative complications and mortality. (6)

Screening Tools

The Canadian Nutrition Screening Tool (CNST) is a valid and reliable screening tool to identify those patients at risk of malnutrition in the adult acute care environment. (1)

Prehabilitation and Optimization Algorithm

Prehabilitation and Optimization Recommendations

Patient Education
  • Patients that are at high risk for malnutrition (CNST 2) require dietician assessment. It is essential that the patient is able to meet their energy, carbohydrate, and protein needs prior to surgery. For 2-4 weeks prior to surgery an increase in dietary protein (aiming for 1.2-2 g/kg/day) may be recommended.
  • Refer to online patient resources
Referral for Nutrition Counseling
  • Dietician to confirm diagnosis of malnutrition and advise dietary plan for optimized nutrition before surgery
  • Refer to online provider resources for dietician resources and referral templates

References

1. Laporte, M., Keller, H. H., Payette, H., Allard, J. P., Duerksen, D. R., Bernier, P., Jeejeebhoy, K., Gramlich, L., Davidson, B., Vesnaver, E., & Teterina, A. (2015). Validity and reliability of the new Canadian Nutrition Screening Tool in the 'real-world' hospital setting. European journal of clinical nutrition, 69(5), 558–564. https://doi.org/10.1038/ejcn.2014.270

2. Wong, H. M. K., Qi, D., Ma, B. H. M., Hou, P. Y., Kwong, C. K. W., Lee, A., & Prehab Study Group (2024). Multidisciplinary prehabilitation to improve frailty and functional capacity in high-risk elective surgical patients: a retrospective pilot study. Perioperative medicine (London, England), 13(1), 6. https://doi.org/10.1186/s13741-024-00359-x

3. Duerksen, D. R., Keller, H. H., Vesnaver, E., Laporte, M., Jeejeebhoy, K., Payette, H., Gramlich, L., Bernier, P., & Allard, J. P. (2016). Nurses' Perceptions Regarding the Prevalence, Detection, and Causes of Malnutrition in Canadian Hospitals: Results of a Canadian Malnutrition Task Force Survey. JPEN. Journal of parenteral and enteral nutrition, 40(1), 100–106. https://doi.org/10.1177/0148607114548227

4. Duerksen, D. R., Keller, H. H., Vesnaver, E., Allard, J. P., Bernier, P., Gramlich, L., Payette, H., Laporte, M., & Jeejeebhoy, K. (2015). Physicians' perceptions regarding the detection and management of malnutrition in Canadian hospitals: results of a Canadian Malnutrition Task Force survey. JPEN. Journal of parenteral and enteral nutrition, 39(4), 410–417. https://doi.org/10.1177/0148607114534731

5. Allard, J. P., Keller, H., Jeejeebhoy, K. N., Laporte, M., Duerksen, D. R., Gramlich, L., Payette, H., Bernier, P., Vesnaver, E., Davidson, B., Teterina, A., & Lou, W. (2016). Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force. JPEN. Journal of parenteral and enteral nutrition, 40(4), 487–497. https://doi.org/10.1177/0148607114567902

6. Martínez-Ortega, A. J., Piñar-Gutiérrez, A., Serrano-Aguayo, P., González-Navarro, I., Remón-Ruíz, P. J., Pereira-Cunill, J. L., & García-Luna, P. P. (2022). Perioperative Nutritional Support: A Review of Current Literature. Nutrients, 14(8), 1601. https://doi.org/10.3390/nu14081601

Surgical Prehabilitation Toolkit