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 with a CNST score of 2 are at high risk for malnutrition and require dietician assessment. It is essential that the patient is able to meet their 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. (9) If individual is malnourished, total protein increases to 1.5-2.0 g/kg/day (10). Refer to online patient resources

Referral for Nutrition Counseling

Dietician to assess for malnutrition and provide a plan to optimize 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. Impact of malnutrition on early outcomes after cancer surgery: an international, multicentre, prospective cohort study

7. 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

8. Gillis, C. and Weimann, A. (2025). Prehabilitation in surgery - an update with a focus on nutrition. Curr Opin Clin Nutr Metab Care. 28(3), 224-234.

9. Gillis, C. and Wischmeyer, P.E. (2019). Pre-operative nutrition and the elective surgical patient: why, how and what? Anesthesia, 74(Suppl.1), 27-35.

10. Durrand J., Singh, SJ., Danjoux, G., (2019). Prehabilitation. Clin Med (Lond). 19(6), 458-464.