Nutritional Optimization
Good nutrition may be the most important predictor of your outcomes from orthopaedic surgery.
Consequences of Malnutrition in Surgical Patients
Reduced caloric intake results in loss of fat, muscle, skin, and ultimately bone and viscera, with subsequent weight loss, and expansion of the extracellular fluid compartment.
Nutritional requirements decrease as an individual’s body mass decreases, reflecting more efficient utilization of ingested food and a reduction in work capacity at the cellular level.
However, the combination of decreased tissue mass and reduced work capacity impedes normal homeostatic responses to stressors such as surgery or critical illness.
The stress of surgery or trauma creates a catabolic state, increasing protein and energy utilization. Macronutrients (fat, protein, and glycogen) from the labile reserves of fat tissue and skeletal muscle are redistributed to more metabolically active tissues such as the liver and visceral organs. This response can lead to the onset of protein-calorie malnutrition (defined as a negative balance of 100 g of nitrogen and 10,000 kcal) within a few days. The rate of development of postoperative malnutrition for a given individual depends upon their preexisting nutritional status, the nature and complexity of the surgical procedure, the degree of postoperative hypermetabolism, and their ability to consume an optimal number of calories.
Malnutrition is associated with several negative consequences, including:
- Increased susceptibility to infection
- Poor wound healing
- Increased frequency of decubitus ulcers
- Overgrowth of bacteria in the gastrointestinal tract
- Abnormal nutrient losses through the stool
Optimizing Nutrition
Eating healthy and avoiding unnecessary weight loss prior to your procedure is ideal. Nutritional status is a major determinant of outcomes for any type of surgery, especially for high-risk patients. Many patients are asked to lose weight prior to joint replacement surgery.
Prior to your surgery your diet should include:
- Protein: High-quality, low-fat protein is a key component of a healthy diet
- Fruits: 2-4 servings per day of your choice
- Vegetables: 3-5 servings per day of your choice
- Dairy: 2-3 servings per day
- Fats: Use sparingly, some fat is necessary, avoid trans fats whenever possible
Dr. Syal does recommend proper weight maintenance with adequate nutrition before heading into your procedure. This will ensure you have adequate strength post-surgery for rehabilitation. There is strong evidence that your nutrition prior to and after surgery will have the greatest significant impact on your recovery and can enhance your overall outcomes. Most patients, especially elderly individuals are not meeting their daily protein needs and with surgery the body requires an increased demand for healing and muscle growth which is powered primarily by protein synthesis. It is recommended that patients undertake a preoperative nutritional supplement fortified with proteins, essential vitamins and minerals a few weeks before their surgery and to continue with this supplement strategy for several weeks postoperatively.
Enhanced Recovery After Surgery (ERAS) evidence supports that patients realize faster recovery, improved muscle volume, enhanced functional recovery, and accelerated return to activities of daily living when utilizing a nutritional supplement plan. Dr. Syal can recommend the appropriate nutritional supplement for you to begin with as you plan for your surgery.
Targeted Nutritional Supplementation is the preferred method to provide precision nutritional optimization to enhance the post operative recovery. Dr. Syal has partnered with Xcelerated Recovery®, this is a surgeon-formulated and third party tested recovery supplement that offers faster return to functional activity through a simple and evidence-based nutritional supplement. The XR® Surgical Recovery Program includes the prepared packets of pre and post-surgery drink mixes for a 3-week period surrounding the surgery date.
Learn about XR – Xcelerated Recovery®
Shoulder Arthroplasty Research Studies | Xcelerated Recovery – Xcelerated Recovery®
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