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Having Surgery Is Like Running a Marathon


Most people would not participate in a 5K run without training. Yet folks go for elective surgery every day without building their nutritional status and improving their physical conditioning.  Studies over many years have shown the value of sound nutritional status on surgical outcomes like wound healing, faster recovery, shorter hospital stays and fewer complications. Gaining control of elective surgical preparation is a win-win for the health plan in terms of cost savings and for the patient, who optimizes their speed of recovery and minimizes the chance of complications.

Malnutrition comes in many shapes and sizes, but professionals with an Intelligent Analytics Engine can find vulnerable individuals, and take pre-emptive action to get them in shape for their big “event”.  Simple  in-office screening enhances the probability of identifying folks that are not quite ready for surgery. Elective surgery can often be postponed until the person is in the best possible condition.

Malnutrition, compromised immunity and protein deficiency adversely impact a person’s ability to heal and quickly bounce back from surgery. There is little doubt that people in better health and nutritional condition fare better and heal sooner than those who are nutritionally compromised—and that resulting health plan costs are lower!

One recent study underscores the impact of malnutrition on morbidity, mortality and hospital length of stay for individuals having elective surgery. On admission day, 1,244 individuals slated for elective surgery took a Nutritional Risk Screening to determine their nutritional status pre-operatively. Three hundred (300 of the 1,244) were shown to be at risk for malnutrition, and subsequently had more complications, higher costs and longer lengths of stay than those with adequate nutrition.

In another study of 887,189 cases from 1,368 hospitals, the conclusion was that malnourished patients are twice as likely to get a surgical site infection, four times more likely to get a pressure ulcer, and five times more likely to have a catheter-related infection. 

Another article entitled, “Malnutrition and healthcare-acquired infections- the need for policy change in an evolving healthcare landscape,” underscores the significance of malnutrition as a key factor in developing a Healthcare Acquired Infection (HCAI).  

Did you know that:

  • HCAI’s affect 5 to 10% of all hospitalized patients in the USA and Western Europe.
  • Payors, especially in the public sector, balk at paying for HCAI’s.
  • About 1 of every 3 individuals admitted to the hospital are in a malnourished condition.
  • Enhancing nutritional status prior to surgery can significantly improve post-operative outcomes

 

Over the past two years, Dr. William Wooten, the director of operative services and a plastic surgeon frustrated with slow post-surgical healing, built on research done by a University of Pittsburgh surgeon in the Impact Advanced Recovery project, by filling pre-operative “red bags” for his patients with items designed to optimize surgical outcomes and minimize impaired healing, long recoveries and costly complications. His “red bags’ included a supplemental drink, fish oil and Gatorade.  It’s all about boosting the immune system, being adequately hydrated and having some liquid calories onboard to weather the stress of surgery. Like so many projects that involve dietary improvements preoperatively, results can be impressive.

The point is, “A stitch in time saves nine!”  We know that some surgical candidates cannot get adequate nutrition for many reasons related to complex medical or socioeconomic issues.  Nonetheless, many elective surgical candidates can take steps to boost their nutritional status. It’s really quite an easy fix to prevent problems, conserve resources and increase chances for operative success. What’s needed is common sense thinking and greater utilization of approaches such as using analytics to enable Nurse Navigators to find and engage vulnerable people proactively.

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