Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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P atients who go NPO in the hours leading up to their surgeries aren't physically prepared for the physi- cal trauma they're about to endure. "Surgery is a major stress on the body," says Steven Bisch, MD, FRCSC, BMSc, a surgical fel- low in the division of gynecologic oncology at Tom Baker Cancer Centre in Calgary, Alberta. "Individuals who are malnour- ished have a harder time recover- ing and are at increased risk of complications." Malnourishment can be caused by disease factors, dietary habits and by traditional perioperative practices such as excessive peri- ods of fasting and bowel prepara- tion, according to Dr. Bisch. "Studies have shown that the time- ly identification and correction of preoperative malnourishment improves surgical outcomes and patients' quality of life," he says. "Awareness of this aspect of surgical care is growing among healthcare providers, often as it relates to comprehensive, evi- dence-based care pathways such as Enhanced Recovery After Surgery (ERAS)." For patients, prolonged fluid fasting can lead to more anxiety, PONV and poor patient experiences, says Daniel Orlovich, MD, PharmD, a clinical instructor in the department of anesthesiology at Stanford (Calif.) Health Care. Even just four hours of fasting before surgery can result in the depletion of glycogen and dehy- dration, according to Dr. Bisch. Glycogen acts as an immediate source of nutrition to fuel repair dur- ing and immediately following surgery. "In the absence of glycogen, the body must rely on slower sources of energy, and often utilizes protein as an energy source," explains Dr. Bisch. "These energy sources are less responsive and delay the healing process, and can contribute to the breakdown of muscle tissue." When the body is deprived of nourishment, it goes into a fasting state, during which it attempts to conserve as much energy as possible. "A fasting state leads to insulin resistance as the body tries to avoid using resources — this is not conducive to healing and tissue growth," says Dr. Bisch. "Insulin helps healing by acting as a growth factor for tissue and by allowing glucose to enter cells for use." Insulin resistance leads to hyperglycemia and impaired immune function, especially in patients with underlying impaired glucose tolerance and dia- betes, according to Dr. Bisch. He says hyper- glycemia is independently associated with Dan Cook | Editor-in-Chief Satiated Before Surgery Pre-op nutrition is a major component of priming patients for procedures. PRIMED FOR SUCCESS A well-balanced diet and carbohydrate-rich supplement drinks improve post-op healing and con- tribute to positive outcomes. 3 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 1 Lynda Schoppe