Nutrition Before Surgery: Setting the Foundation for Recovery

What Does “Being Ready for Surgery” Really Mean?

When a surgeon says "you’re cleared for surgery," most patients think they have checked all the boxes: the blood work is done, the EKG looks good, and the calendar is marked.

However, true surgical readiness isn’t just about passing tests; it’s about your body's resilience. Think of surgery like a marathon. You wouldn't show up to the starting line of a 26-mile race without fueling properly, and surgery is no different. A vital, often overlooked, part of surgery preparation is nutrition, which is key to prepare the body for the impact of surgery. Like a marathon, this preparation is essential to ensure the body has the specific building blocks it needs for a successful event and recovery. By considering nutrition prior to surgery, you are already taking the first step to help future you recover from your procedure.

Malnutrition Is More Common Than Most Patients Realize

What exactly does it mean to consider your nutrition? One of the most important things to think about is preventing malnutrition. This is defined as having a deficiency, an excess, or an imbalance of energy and other macronutrients like protein, or micronutrients like vitamin D and calcium. For patients having surgery, malnutrition is linked to a higher risk of infection, slower wound healing, and longer stays in the hospital (1). You may not think malnutrition is something you have to worry about, but it is actually much more common than most people think. It is estimated that between 20% and 50% of orthopaedic patients are malnourished (2).

There is a common misconception in thinking that malnutrition only applies to people who are severely underweight. In reality, malnutrition is about the quality of your body's fuel, not just the amount of food you eat. Even if someone gets enough calories in their diet, they may not be getting the right amounts of vitamins, minerals, and protein that they need. Over time, this can lead to a deficiency. For people who consistently do not get enough calories, such as those taking medications like Ozempic or those with a low appetite, the risk of malnutrition and deficiency is even higher.

Some deficiencies often seen in orthopaedic patients are vitamin D and protein. Vitamin D deficiency is common in adults and is found in about 35% of the adult population in the US (3). As for protein, the amount of protein your body needs actually doubles after a surgery. This can make it very difficult for patients to eat enough to meet their needs. It is important to work on preventing these deficiencies because vitamin D and protein are both essential for your recovery after surgery.

How Nutrition Can Affect Surgical Outcomes

If your "fuel tank" is empty or filled with the wrong nutrients, your recovery can hit a wall. When the body lacks key resources, it focuses on basic survival instead of the best possible healing. This can lead to a higher risk of infection, muscle loss, tiredness, and slower wound healing.
There are a few key nutrients that are especially important for supporting a healthy recovery. Below, these nutrients are outlined to show how they can help you recover.

Protein: Getting enough protein after surgery is essential because your body needs it to heal wounds, rebuild muscle, and get your strength back. Protein provides amino acids, which are the building blocks of muscle. They are incredibly important to help you rebuild your muscle after your procedure and help prevent too much muscle loss.
Leucine: Leucine is one specific amino acid that acts like the "on switch" for building muscle. Because of this, it is important to eat high-quality proteins that have a high amount of leucine (at least 3 grams per serving).
Vitamin D & Calcium: Getting enough calcium and vitamin D is essential to help your body heal bone properly, lower the risk of problems after surgery, and support long-term joint and bone strength. Research has shown that if you are not getting enough calcium and vitamin D in your diet, you are at a greater risk of complications from your surgery (4,5).
Creatine Monohydrate: Creatine is a nutrient that helps your body create more energy to support your muscles during movement and recovery. Creatine has been shown to increase muscle strength, which leads to more muscle building (6). For surgery patients, this can make it easier to get back on your feet and become independent again sooner.

Nutrition: Your Secret Weapon

Surgery can feel like a whirlwind of things happening to you, but nutrition is a variable you can control. By shifting your focus to your plate in the weeks before and after your procedure, you are actively participating in your own success by preventing malnutrition, building your nutrient reserves, and increasing your energy. It is one of the most effective ways to prepare your body for your procedure and help support your recovery before you even enter the operating room.

Nutrition Tips:

Prioritize Protein: Aim for 1.2–2 grams of protein per kg of body weight daily to build muscle and prevent muscle loss during recovery.
Eat a Balanced Diet: Focus on a wide variety of whole foods to ensure your body has the diverse nutrients it needs to repair itself.
Limit Inflammatory Foods: Reduce refined sugars and processed fats to keep your body’s inflammation low and streamline the repair process.
Stay Hydrated: Drink water regularly and stay hydrated all day long.
Supplement Wisely: Use protein shakes or vitamins if you can't meet targets through your diet.

Note: Follow your surgeon's nutritional and fasting recommendations for the night before surgery and the day of surgery.

Scientific References:

Cass AR & Charlton KE. Prevalence of hospital‐acquired malnutrition and modifiable determinants of nutritional deterioration during inpatient admissions: A systematic review of the evidence. J Hum Nutr Diet. 2022;35(6):1043-1058.
Dubé MD et al. Nutritional Assessment and Interventions in Elective Hip and Knee Arthroplasty: a Detailed Review and Guide to Management. Curr Rev Musculoskelet Med. 2022;15(4):311-322.
Kaur J et al. Vitamin D Deficiency. StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL). 2025 .
Kong Y et al. The Association of Calcium and Vitamin D Use With Implant Survival of Total Knee Arthroplasty: A Nationwide Population-Based Cohort Study. J Arthroplasty. 2021;36(2):542-549.
Cancienne JM et al. Perioperative Serum 25-Hydroxyvitamin D Levels Affect Revision Surgery Rates After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2019;35(3):763-769.
Chilibeck PD et al. Effect of creatine supplementation during resistance training on lean tissue mass and muscular strength in older adults: a meta-analysis. J Sports Med. 2017;8:213-226.

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