Preoperative nutrition program enhances patient recovery

A system-wide preoperative nutrition program improves patient outcomes and offers the potential for substantial cost savings for health care systems, according to a new study being presented at the American College of Surgeons (ACS) Clinical Congress 2024 in San Francisco, California. The study findings highlight the value of using nutrients to support the immune system before surgery to reduce hospital stays and decrease postoperative complications.

Our findings show that incorporating preoperative nutrition as a standard part of surgical care can lead to significant reductions in health care utilization and costs. These results emphasize the importance of routine nutritional support in the preoperative period to enhance patient recovery and reduce financial burdens on health care systems."

Edward A. Joseph, MBBS, lead author and cancer clinical outcomes research fellow at the Allegheny Health Network

Study overview

Researchers analyzed administrative claims data from 4,078 surgical cases within the Allegheny Health Network health care system, spanning eight surgical specialties. They conducted a systematic review to project the impact of preoperative nutrition on hospitalization and long-term complication rates. The review found an average 18% reduction in hospital stays and a 33% decrease in complications, translating to a cumulative reduction of 2,699 hospital days (HD) and 865 outlier days (HD>30) over the study period, ultimately resulting in a projected annual savings of $7.8 million.

Key decreases in health care utilization included:

• 865 outlier days reduced: The program notably reduced "outlier days," defined as hospital days exceeding expected duration, which are a significant cost to payers. This reduction alone accounted for $6.1 million in projected savings. 

• Long-term complication decrease: By decreasing the rate of long-term complications, the study projected an additional $1.9 million in savings. 

Projected financial impact

The study projected the total health care utilization cost for the analyzed procedures to be approximately $130.9 million. Implementing the preoperative nutrition program, which costs about $244,680 annually (4,078 patients at $60 per nutrition bundle), resulted in an estimated total savings of $7.8 million annually for the payer/insurance sector. Health care providers benefit from the overall reduction in hospital days and decreased complications, which can translate to better resource utilization and potential cost savings in terms of staffing, bed availability, and other operational costs.

These nutrition packages, available over the counter, consist of immunonutrition shakes filled with omega-3 fatty acids and arginine to support immune health and surgical recovery. Before surgery, this nutrition package helps patients "carbo-load," which can improve general well-being both before and after surgery. Nutrition programs were primarily used for cancer patients in the past, but there may be benefits in expanding to more surgical patients.

According to the study authors, adopting a system-wide preoperative nutrition program can enhance patient outcomes significantly while providing a substantial financial benefit to payers and providers. "These findings underscore the need for more widespread implementation of preoperative nutritional support, as it offers a clear path to improving care and reducing costs," Dr. Joseph said.

Co-authors are Nathan Bloom, MBA, BS; Camille Hamlet, MBA, MHA, BSN, RN-BC; David L. Bartlett, MD, FACS; Sricharan Chalikonda, MBBS, FACS; and Casey J. Allen, MD, FACS.