INTEGRATION OF NUTRITIONAL SUPPORT IN ORTHOPEDICS: DIETARY AND NUTRITIONAL ASPECTS OF SURGICAL PATIENTS

The nutritional support in orthopedic surgery is an unclear idea to date. In these years, the goal of this project has been to clarify what is meant by nutritional support in patients undergoing hip or knee replacement and spine surgery, demonstrating its value in relation to the perioperative path. This aim was pursued by applying a methodology of first studying the literature, then analyzing the setting, evidencing shortcomings, proposing management protocols, and verifying the effectiveness of nutritional strategies. The literature search highlighted the multiple phases that should be coordinated, including prehabilitation, perioperative, and postdischarge management. When applying optimization strategies, such as anemia correction, it may be necessary to examine the eating behavior and anticipate the metabolic responses according to the patient’s state of health. The predictive potential of hemoglobin on the clinical outcome in spine surgery has been investigated through retrospective analysis of existing data, suggesting the need to refine decision-making algorithms that identify the patients to be treated, underlining the importance of having high hemoglobin values in the preoperative period to have more chances of clinical success. Prospective observational studies confirmed that patients either after spine surgery or arthroplasty do not meet their needs for what concerns energy and proteins. It seems to be vital to redefine the tactics to promote early oral nutrition, counteract the depletion of body reserves, and acknowledge the impairment of the olfactory stimulus caused by anesthetic drugs. More transparent information on diet and nutrition should be conveyed to patients. The nutritional support program might include a healthy eating education that teaches the concepts of nutritional value, quantity, quality, and timing. Clear information on what to eat or not to eat before surgery must be accompanied by dietary advice also for postoperative recovery. New management proposals can integrate aspects of healthy eating education into a multimodal approach that includes advice on increasing physical activity and promoting night sleep. A risk management system inspired by the hazard analysis and critical control points system can be effectively applied before orthopedic surgery to manage malnutrition. The interventional trials proved that nutrient deficiencies, including those of vitamin D and iron, are common in the surgical population. Dietary supplements should be carefully selected for what concerns the pharmaceutical formula, as well as for the content of important cofactors that may be necessary to boost the metabolic response. Early cardiovascular effects can derive from correcting hypovitaminosis D with a liquid form of vitamin D, and promising data on enhancing preoperative hemoglobin values can derive from using a supplement containing iron and B vitamins. The future of perioperative medicine in orthopedic surgery should choose a pragmatic integration of dietary and nutritional aspects in orthopedics, thus possibly improving health performance and patient experience.