Pre-Surgery Optimization Protocol

Timing: Ideally 4 weeks before surgery (minimum 2 weeks for nutritional optimization)

Smoking cessation: Mandatory - quit minimum 4-6 weeks before (ideally 8+ weeks). Smoking impairs wound healing, increases infection risk, respiratory complications, anesthesia issues. Use all tools: NRT, Chantix, counseling

Alcohol cessation: Stop 2+ weeks before (alcohol impairs healing, increases bleeding, anesthesia complications)

Optimize blood sugar: If diabetic, A1C <7% (ideally <6.5%) - high glucose impairs wound healing, increases infection risk dramatically. Tight control 4+ weeks pre-op

Nutrition: High-protein diet 1.2-1.6 g/kg (protein needed for healing - aim 100-150g daily), adequate calories (no dieting pre-surgery - need anabolic state), colorful vegetables (micronutrients)

Vitamin D: Optimize 40-60 ng/ml (low D increases infection risk, impairs healing) - load with 5000-10,000 IU daily for 4 weeks

Vitamin C: 1-2g daily for 2 weeks pre-op (collagen synthesis, wound healing, immune function)

Zinc: 30-50mg daily (wound healing, immune function)

Vitamin A: 10,000-25,000 IU daily for 2 weeks pre-op (epithelialization, immune function) - stop 1 day before surgery

Arnica: 30C homeopathic 2-3 pellets 3x/day starting 3-5 days before surgery (reduces bruising, swelling - popular in plastic surgery, mixed evidence but safe)

Bromelain: 500mg 3x/day between meals starting 2 days before (reduces swelling, inflammation - mixed evidence)

Probiotics: 25-50 billion CFU daily for 2 weeks (reduces post-op infection risk, especially GI surgeries)

Discontinue: Stop 1-2 weeks before surgery (bleeding risk or anesthesia interaction): High-dose omega-3/fish oil (>1g), vitamin E >400 IU, ginkgo, garlic supplements, ginger, turmeric/curcumin (high-dose), dong quai, feverfew, ginseng. Continue: Vitamin D, vitamin C, zinc, probiotics, arnica. Check with surgeon/anesthesiologist

Bowel prep: If GI surgery, mechanical bowel prep + oral antibiotics as directed, otherwise not needed

Carbohydrate loading: Night before and morning of surgery (if allowed by anesthesia - check), drink clear carbohydrate drink (reduces insulin resistance post-op, nausea, improves recovery) - used in ERAS protocols

Optimize weight: If significantly overweight and elective surgery, lose 5-10% body weight (reduces complications). If underweight, gain weight (malnourished patients have much worse outcomes)

Exercise: Maintain regular exercise up to 3-5 days before surgery (improves cardiovascular fitness, recovery - but don't overdo and risk injury)

Prehabilitation (prehab): If major surgery (joint replacement, abdominal), physical therapy or conditioning program 4-6 weeks before (improves post-op outcomes)

Mental preparation: Relaxation techniques, visualization (imagining successful surgery and recovery - shown to improve outcomes in studies), address anxiety (meditation, therapy, anxiolytics if needed - uncontrolled anxiety worsens outcomes)

Medication review: Review all medications and supplements with surgeon/anesthesiologist - adjust diabetes meds, blood pressure meds, anticoagulants per protocol

Optimize iron: If anemic (especially if anticipated blood loss), iron supplementation 4+ weeks before (ferrous sulfate 325mg 2-3x/day or iron infusion if severe) - anemia increases complications

Stop NSAIDs: 5-7 days before (bleeding risk) - switch to acetaminophen for pain

Clear liquids: Typically allowed up to 2 hours before surgery (old NPO after midnight is outdated - causes dehydration, discomfort. Check anesthesia guidelines)