Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dianne Conrad

Second Advisor

Katie Mann

Third Advisor

Patricia Thomas


Each additional hospital day related to a surgical complication costs an estimated $1,000 (Grusky et al., 2015). Due to the rising costs of healthcare, European professors designed Enhanced Recovery After Surgery pathways to mitigate potential adverse surgical outcomes and associated costs. A primary focus of these pathways emphasizes the importance of pre-procedure nutritional optimization. Literature increasingly supports malnutrition as an independent predictor of postoperative complications and increased length of stay (LOS) (Adogwa et al., 2014). The neurosurgical population has a wide variety of comorbidities that place them at increased risk for nutritional compromise. Thus, a perioperative nutrition pathway was implemented at a Midwest neurosurgery office for elective spinal fusion patients. The pathway incorporated twenty-nine (n=29) patients who were screened and provided with Ensure Pre-Surgery drinks preoperatively. Result yielded no statistically significant difference in hospital LOS or 30-day readmission rates among patients in the pathway and those in a historical comparison group. However, the pathway did highlight the importance of a standardized process to identify patients at risk of nutritional compromise. A total of three (n=3) patients received nutrition consults postoperatively due to screening answers and body mass index (BMI) results. Additionally, the pathway identified the need for future guidelines addressing diabetic preoperative clearance. Future recommendations from the pathway highlight the importance of a nutritional algorithm for diabetic patients, utilization of information technology and comprehensive nutritional screening tools.

Additional Files

A. McKay Powerpoint.pdf (13244 kB)