(OR03-02-23) Feasibility of Implementing a Nutrition Optimizing Intervention Before and After Surgery in Malnourished Older Veterans

Objectives: Older adults have reduced adaptive and regenerative capacities to recovery from a surgical insult and when compounded by protein/calorie malnutrition, increased postoperative complications and functional decline are common. Unfortunately, established preoperative malnutrition screening and perioperative interventions to optimize nutrition are lacking. Our objective was to investigate the feasibility and acceptability of a perioperative nutrition intervention providing higher protein intakes before and after surgery in malnourished Veterans.

Methods: Older (≥65 yrs) Veterans with malnutrition as diagnosed using the Nutrition Focused Physical Exam (≥2 of the 6 criteria: low kcal intake, weight, muscle or subcutaneous fat loss, diminished function, edema) undergoing an elective abdominal surgery, were prescribed 1.6 g/kg/bw of protein and instructed to consume 30 g of high-quality protein 3 times/day for 2 weeks before and 4 weeks after surgery. A priori criteria for feasibility and acceptability were defined as ≥80% of participants would be retained and ≥80% would find the intervention acceptable.

Results: Of the 26 malnourished Veterans enrolled (74±7 yrs, 92% male, 54% Black, 62% with a cancer diagnosis), 23 (88%) completed the two-week preoperative intervention and 19 (73%) completed the pre and postoperative intervention. In a satisfaction survey, 94% reported agree or strongly agree that they were glad they participated in the study, 83% and 82% reported the nutrition intervention improved their diet before and after surgery, respectively, and 89% and 63% reported it was easy to consume the protein supplementation 3 times/day before and after surgery, respectively. Additionally, 100% reported weekly phone calls helped them meet their protein goals. None of the participants dropped out of the study due to the burdens of the protein intervention; the only dropouts occurred when there was surgery cancellation or postponement (n=6) or an interoperative complication (n=1).

Conclusions: Protein/calorie malnutrition is a common challenge for older adults facing surgery. Our findings that an intense perioperative nutrition intervention is highly feasible and acceptable in this population have important implications for reducing surgical risk.

Funding Sources: Department of Veterans Affairs Rehabilitation Research and Development Service