Rethinking The Presurgical Fast

Refraining from any food intake ahead of surgery is such a routine instruction that most patients fully expect it’s coming when the litany of preparatory steps is recited. But there’s mounting evidence that a different approach might be preferable.

To learn more, Surgical Products interviewed Christina Sherry, PhD, RD, a scientist with Abbott.

While it’s commonplace for patients to be instructed to fast ahead of surgery, there’s some concern it’s a problematic approach. Can you tell us why?

Research shows fasting before surgery is not the best way to prepare your body for the operation or the recovery process. In a recent survey, which was supported by Abbott, more than 1,000 people were asked what their top concerns were about not eating or drinking after midnight before surgery, and the top responses were nausea (36 percent), dehydration (35 percent), and anxiety (32 percent).

These concerns align with the research that show carbohydrate-loading the night before and up to two hours before surgery can help patients by reducing hunger, thirst, and anxiety before surgery, as well as reducing insulin resistance, nausea, vomiting, and pain after surgery. By using the body of research, surgeons can change of the standard protocol of fasting before surgery so that patients can have the best chances of recovering faster and getting back to enjoying their everyday activities.

What differences have you seen with patients who approach nutrition differently in the lead-up to surgery?

The impact of nutrition before and after surgery is important. There’s a wealth of research that shows the benefits of nutrition, particularly immunonutrition and carbohydrate-loading, before surgery on surgical outcomes, ranging from supporting the immune system and helping to reduce wound and infection complications after surgery to shortening a patient’s length of stay and reducing hospital costs.

What factors did Abbott consider in the development of the Ensure drinks?

As a science-based company, Abbott looked at the clinical research that shows the role of nutrition in patients undergoing surgery and how we can develop great-tasting nutrition products that provide the best nutritional support. In addition, we know that compliance is particularly important to make sure patients are getting the nutrition they need. If you’ve had fish oil before, you know it can have a fishy aftertaste. We worked with our team of scientists and sensory specialists to help “flavor mask” some of these important immune-boosting nutrients.

How does proper nutrition before and after surgery contribute to the recovery process?

Preparing your body for surgery is similar to training for a marathon. Just like you wouldn’t fast before a big race, research has shown that good nutrition can prepare your body to have the strength and energy needed for a major procedure.

During an operation, your body requires a lot of energy due to the significant amount of stress it is put under. This can cause weight and muscle loss, inflammation and complications like infection — but nutrition can help you prepare.  Research shows the role that nutrition can play before and after surgery, including:
•    Immunonutrition has been shown to help reduce wound or infection complications after surgery. In turn, this can reduce time in the hospital and healthcare costs.
•    Carbohydrate-loading has been shown to improve patient outcomes by reducing insulin resistance which can lead to complications, as well as nausea, vomiting, and pain after surgery.

Do you anticipate there will need to be a culture change in the healthcare field in regards to nutrition approaches around surgery? If so, how does that culture shift begin to happen?

Surgical protocols, such as from Enhanced Recovery After Surgery (ERAS), were developed roughly 10 years ago and are widely adopted across Europe. Yet the U.S. has just recently started to adopt them to help patients have a better recovery. Some of the larger institutions like Duke University have been leaders in implementing the nutrition components of these guidelines, which will hopefully encourage more hospitals of all sizes to add nutrition to their recovery process.

Anything else you’d like to add?

Getting the right nutrition before and after surgery is an important part of the recipe to support healing and recovery. Hospitals and healthcare providers should discuss with their patients how good nutrition can help you prepare for and recover from surgery.