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Archive June 2018 XIX, No. 6

Boost Your Patients' Dietary Health Before Surgery

Use a simple checklist to screen for malnourishment.

Thomas Varghese Jr.

Thomas Varghese Jr., MD, MS


SURGICAL NUTRITION Nutritional status is a major determinant of outcomes for any type of surgery, especially for high-risk patients.

It's no secret that malnourished patients tend to have bad outcomes after surgery, but that's not your problem, right? When patients arrive at your facility, you're more concerned with their high deductibles than with their low albumin levels. While you're hardly alone in overlooking your patients' nutritional status, what if I told you it's easy to get your patients in the best possible nutritional shape for surgery — as easy as completing a 4-question checklist to identify those who are malnourished?

Here's the thing: You're perfectly positioned to help. Because outpatient facilities have the luxury of time, you can use the checklist to screen patients from the time they schedule surgery to the day they show up for their procedure. Yes, it requires coordination among your facility, your surgeons, and local dietitians or nutrition experts, but pre-op nutrition screening can lead to happier, healthier patients.

A bit of background: A few years ago, a few physicians and I developed Strong for Surgery (S4S), a public health campaign that engages patients and their surgeons to improve overall health and increase the likelihood of a positive surgical outcome ( The free program targets 4 areas that are known to be highly influential determinants of surgical outcomes: nutrition, glycemic control, medication management and smoking cessation. Today we'll focus on surgical nutrition.

Nutrition screening checklist

You can screen for malnutrition in 60 seconds. The Strong for Surgery nutrition screening checklist asks patients 4 questions to determine if the patient is malnourished. If the patient answers "YES" to any of them, you should refer her to a registered dietitian for nutritional assessment and intervention to improve the patient's condition before surgery.

  • Is BMI less than 19?
  • Has the patient had unintentional weight loss of over 8 pounds in the last 3 months?
  • Has the patient had a poor appetite — eating less than half of his meals or fewer than 2 meals per day?
  • Is the patient unable to take food orally (dysphagia or vomiting, for example)?

Additionally, for inpatient procedures, the checklist also suggests testing the patient's albumin level to ensure it's not less than 3.0 g/dL. (Historically, we have used low albumin as an indicator of malnutrition, but relying on albumin levels alone may falsely diagnose patients as malnourished.) For complex GI surgeries, the checklist also suggests giving the patient evidence-based immune modulating supplementation.

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