Preoperative Nutritional Optimization in Older Patients Reduces Complications

More than 50% of older surgical patients are thought to have malnutrition.1 Poor nutrition is associated with increased postoperative complications, prolonged length of hospitalization, and increased health care costs.2 In terms of modifiable preoperative risk factors, malnutrition is one of the few that is associated with poor surgical outcomes, including mortality.3,4 Although referral to a dietitian may be ideal for certain patients, there can be multiple barriers to implementation. Supplementation for a minimum of five days for low-risk patients and seven days for those at higher risk has been recommended.5 A patient at higher risk would have an albumin level of less than 3.0 g per dL (30 g per L) or would meet any of the following criteria: body mass index of less than 20 kg per m2 if older than 65 years, unplanned weight loss of more than 10% of total body weight in the past six months, or eating less than 50% of a person's normal diet in the past week. Patients with dentures should be reminded to bring them to the hospital to facilitate appropriate caloric intake postoperatively.1 Current studies are too heterogeneous and lack conclusive evidence that preoperative oral nutritional support with dietary supplements improves outcomes for patients undergoing surgery.2 Other barriers include adding supplements in patients who may already take a number of medications and our limited understanding of how these natural supplements may or may not interact with a patient's current medications, especially given concerns around the lack of U.S. Food and Drug Administration monitoring for nutritional supplements.