Posted November 29, 2024; Written by Caiden McPherson

Proper nutrition plays a vital role in recovery from surgery, but how many patients are meeting the recommended nutritional intake before their surgery? And how much does nutrition actually matter? Malnutrition is defined by a lack of quality nutrients within one’s diet, leading to deficiency, excess, or imbalance of nutrients within the body. Malnutrition is a leading risk factor to impaired healing following a surgical procedure with potential increased risk of infection, wound reopening, and extending the time needed to recover (Seth et. al., 2024). While the word malnutrition may conjure images of someone who is emaciated, many Americans struggle to get the nutrition they need in their diets daily. 

Across the US, typical dietary habits vary between populations within different socioeconomic statuses, leading to differences in both health and diet. One study found that in different regions, anywhere from 50%-91% of orthopedic patients had a suboptimal diet in the time period immediately prior to surgery (Taylor & Francis, 2023). By providing patient education on the nutritional needs of the body prior to and following surgery, orthopedic surgeons have observed better recovery outcomes (Taylor & Francis, 2023). When nutritional information is provided and adhered to by patients, hospital stays are decreased, wounds heal faster, and there are overall less complications. 

Basics of Nutrition

A person’s nutritional status is the product of their intake, absorption, and utilization of both macronutrients and micronutrients. Macronutrients include fats, proteins, and carbohydrates. Micronutrients include a variety of vitamins, minerals, and other substances that are essential to overall health. Additionally, adequate hydration is an important aspect of an individual’s health. Nutritional needs vary somewhat between each person, depending on age, sex, chronic conditions, and other factors; however, there are some general guidelines that can help shape a balanced diet.

In general, a person can achieve proper nutrition by prioritizing high quality whole foods. Fruits and vegetables qualify as complex carbohydrates and it is recommended to eat 2-3 servings of both fruits and vegetables each day (Taylor & Francis, 2023). Fruits and vegetables provide numerous nutrients such as fiber, vitamins, antioxidants, and minerals to help promote wellness and healing (Hirsch et. al., 2021). Whole wheat breads, oats, and wild rice are also good sources of high quality carbohydrates. Additionally, it is recommended to eat varying sources of protein throughout the week. One review stated that people can achieve adequate nutrition by eating 3-4 portions of plant based protein–such as beans or other legumes, 3-4 portions of seafood, 2-3 portions of eggs, and 2-3 portions of meat throughout the week (Taylor & Francis, 2023). These foods provide high quality protein along with necessary micronutrients and high quality fats–such as the omega 3 fatty acids found in fish. It is important to eat both plant-based and animal-based proteins to get a variety of nutrients in the diet (Taylor & Francis, 2023). Whenever possible, it is advised to avoid heavily processed food, as the nutrients are low quality and they are commonly filled with fillers and extra chemicals. The fillers and excess calories in highly processed food often lead to feelings of fullness without providing adequate nutrition. While no one diet is perfect for everyone, these guidelines can help direct individuals to finding a diet that is right for them. 

Surgery & Nutritional Demand

Surgery, while beneficial, is stressful on the body. Immediately following surgery, the body undergoes a stress response in order to compensate for tissue damaged by incisions and other surgical processes (Williams & Wischenmeyer, 2019). When the body undergoes this stress response, the nutritional demands of the body increase. One of the main reasons nutritional demand increases is due to wound healing. Wound healing is energy intensive and requires an adequate supply of water, macronutrients, and micronutrients. To best prepare the body for surgery, it’s important to consider the nutritional needs of the body before and after surgery.

Hirsch et. al. (2021) states, “The goal of pre-operative nutrition is to ensure adequate energy stores to meet the demands of the stress state. The goal of post-operative nutrition, on the other hand, is to promote nitrogen balance, reduce the loss of lean mass, and facilitate rapid healing and recovery.” It is important to increase quality protein consumption and to consume high quality carbohydrates at least 7-10 days before surgery. Patients can achieve this by eating whole grain foods, whole fruits and vegetables, and responsible portions of quality protein such as dairy, meats, and legumes. Whole grains, fruits, and vegetables generally have a high ratio of nutrients per calorie compared to processed foods, leading to a better supply of nutrients. Patients who ate balanced whole food diets the week before surgery had a lower rate of complications, such as infection and wound reopening (Hirsch et.al., 2021). Many surgical centers will give their patients guidelines about what to eat prior to surgery and when to stop eating in the 24 hours before surgery. It proves very beneficial to speak to a doctor and/or a registered dietician or nutritionist prior to the week of surgery to get guidelines that fit each individual’s lifestyle and unique situation. 

Following surgery, increasing protein intake is vital to supporting a positive surgical outcome. The body uses protein in every step of the healing process, from regulating inflammation and the immune system, to healing incision sites and building healthy muscles (Seth et.al.,2024). Typically following a surgery, it is common for patients to lose weight, however this puts patients – especially those over the age of 65 – at a higher risk for loss of muscle mass and strength (Taylor & Francis, 2023). According to a peer reviewed study in the journal Nutrients, patients who used amino acid supplements after orthopedic surgery under the instruction of a nutritionist or healthcare professional had better surgical outcomes including better joint function, decreased muscle loss, and increase in overall muscle strength when combined with physical therapy (Hirsch et.al., 2021). One suggestion to increase protein, is to ensure that there is protein rich foods included in every meal and snack, such as protein shakes, cheese, or other dairy products. By increasing protein intake, patients increase their body’s ability to maintain and build muscle following orthopedic surgery and decrease their risks for muscle loss and delayed healing.

In addition to increasing protein intake, patients recovering from orthopedic surgery can benefit from keeping a close eye on hydration and micronutrients. The body uses water throughout the healing process to transport nutrients and remove waste products from the incision site. With the increase in water usage, post-surgical patients are at a higher risk for dehydration compared to healthy adults (Seth et.al. 2024). It’s also important to prioritize water intake over other fluids such as soda and sports drinks to keep blood sugar managed. By increasing water intake, patients can ensure their healing process is streamlined. Researchers have found that deficiencies in vitamins A, B, and C all lead to impaired immune function, leading to a higher risk of infection (Seth et.al., 2024). By eating a balanced diet with whole foods — such as fruits, vegetables, and whole grain products — most individuals can ensure they are getting a proper amount of vitamins and minerals. By prioritizing nutrition and hydration, patients can prevent healing delays caused by infection and malnutrition. 

In Summary

Malnutrition is heavily associated with negative surgical outcomes. Patients who are deficient in vitamins, protein, or hydration are at a higher risk of developing infections and consistently have longer healing times. It’s important to prioritize proper nutrition before and after surgery to get the most out of a surgical procedure. Surgery puts extra stress on the body, so making sure the body is equipped with the nutrients it needs is essential to achieving greater function. Chronic conditions, age, sex, and lifestyle can all affect the exact amount of nutrients that patients need prior to and following surgery. By speaking with a nutritionist or registered dietician, patients get beneficial information that helps prepare them for optimal surgical recovery. Pairing nutritional education with physical therapy leads to the greatest success following orthopedic surgery. By staying hydrated, eating a variety of protein and whole foods, patients can give their body the tools it needs to recover from surgery.

The information in this article is intended for educational use only and is not intended to diagnose, treat, or cure any medical condition. Always consult a healthcare professional before making any decisions related to your health.

Works Cited:

Hirsch, K. R., Wolfe, R. R., & Ferrando, A. A. (2021). Pre- and Post-Surgical nutrition for preservation of muscle mass, strength, and functionality following orthopedic surgery. Nutrients, 13(5), 1675. https://doi.org/10.3390/nu13051675

Seth, I., Lim, B., Cevik, J., Gracias, D., Chua, M., Kenney, P. S., Rozen, W. M., & Cuomo, R. (2024). The Impact of Nutrition on Skin Wound Healing and Aesthetic Outcomes: A comprehensive narrative review. JPRAS Open, 39, 291–302. https://doi.org/10.1016/j.jpra.2024.01.006

Taylor & Francis. (n.d.). Healthy Eating for Elective Major Orthopedic Surgery: Quality, quantity, and timing. https://www.tandfonline.com/doi/full/10.2147/JMDH.S415116#d1e950 

Williams, D. G., & Wischmeyer, P. E. (2019). Perioperative Nutrition care of Orthopedic surgery patient. Techniques in Orthopedics, 35(1), 15–18. https://doi.org/10.1097/bto.0000000000000412