Perioperative Nutrition Plan

☐ 4+ weeks before surgery — screen and build

• ☐ Tell us if any apply: unintentional weight loss (~10 lb in 3 months), poor appetite, BMI under 18.5, or a very restrictive diet — we may check labs (albumin, vitamin D, blood count, HbA1c) and add supplements. Low albumin (<3.5 g/dL) is one of the strongest predictors of surgical complications.
• ☐ Protein: at least 1.2 g per kg of body weight daily (about 90–120 g/day for a 170-lb adult), spread over 3–4 meals of 25–40 g each. Reaching your protein goal matters more than calories.
• ☐ Vitamin D: if you're deficient or rarely in the sun, we replete it — typically 800–2,000 IU of D3 daily. Add calcium 1,000–1,200 mg/day, food first.
• ☐ Diabetes: target HbA1c below ~7.5–8% before elective surgery — higher levels raise infection risk. Ask us before making medication changes.
• ☐ Iron/anemia: if you've been told you're anemic, we address it now — treating it before surgery reduces transfusions.
• ☐ Stop smoking and nicotine: smoking roughly doubles bone-healing failure. Quitting 4+ weeks out significantly cuts complications, and every extra week helps (~19% per week). Ask us about support.
• ☐ Alcohol: if you average more than 2 drinks/day, stop at least 4 weeks before surgery — this measurably reduces complications.
• ☐ Weight loss (if advised): never crash-diet before surgery — losing muscle sabotages recovery. Keep protein high while losing fat.
• ☐ GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound, etc.): tell us AND the anesthesia team. Current guidance keeps most patients on them with a special diet the day before — but the anesthesia team makes the call.

☐ 1–2 weeks before surgery

• ☐ If we flagged you as nutritionally at-risk: oral nutrition supplement 2–3×/day (≥18 g protein per serving) for at least 7 days — we may recommend an "immunonutrition" formula (arginine/omega-3).
• ☐ Joint replacement patients: consider an essential amino acid (EAA) supplement, 20 g twice daily, starting 1 week before surgery — in randomized trials this cut post-operative muscle loss several-fold.
• ☐ Confirm your medication plan (blood thinners, NSAIDs, supplements to hold) per your pre-op instructions.

☐ Night before and day of surgery

• ☐ Evening before: a carbohydrate-rich drink (~100 g complex carbs — per your pre-op packet).
• ☐ Up to 2 hours before anesthesia: a clear carbohydrate drink (≥45 g, such as a clear sports drink) — modern fasting rules allow clear liquids until 2 hours out, and arriving carb-loaded rather than starved reduces post-op insulin resistance and discomfort. Diabetics and anyone given different instructions: follow YOUR instructions.
• ☐ No solid food within 6 hours; no fried/fatty food within 8 hours.

☐ After surgery — feed the healing

• ☐ Protein 1.2–2.0 g/kg/day for the first 6+ weeks. If appetite is poor, use shakes to hit the number.
• ☐ Joint replacement: continue EAA 20 g twice daily for 2 weeks after surgery.
• ☐ Fracture or wrist/ankle surgery: vitamin C 500 mg daily for 50 days — shown to reduce the risk of chronic regional pain syndrome after fracture.
• ☐ Ligament or tendon repair: optional but promising — 15 g collagen or gelatin + vitamin C about 60 minutes before each rehab session (shown to boost collagen production markers).
• ☐ Keep taking vitamin D + calcium; hydrate; resume a normal varied diet as soon as tolerated.
• ☐ NSAIDs (ibuprofen, naproxen): follow YOUR post-op instructions — after some bone procedures we limit them.
• ☐ What about creatine? Safe, but trials after ACL reconstruction and knee replacement showed no clear added benefit — food-first protein and EAAs are where the evidence is.

Evidence base: ERAS® Society and ASPEN enhanced-recovery nutrition pathways; ESPEN surgical nutrition guidelines; ASA 2023 fasting guidelines; Bohl et al. J Arthroplasty 2016 (albumin); Dreyer et al. JCI 2013 & 2018 (EAA/TKA); Zollinger et al. 2007 (vitamin C); Shaw & Baar AJCN 2017 (collagen); WHO 2020 (smoking); Cochrane 2018 (alcohol); 2024 multisociety GLP-1 guidance. Education only — your personal instructions from Dr. Pettit, your anesthesia team, and your pre-op packet always take precedence.