Nutrition and Enhanced Recovery (ERAS) Guidelines
Your recovery begins before surgery.
Preparing your body with good nutrition, hydration, physical activity, and appropriate rest can help support your recovery after orthopaedic surgery. These recommendations incorporate principles of Enhanced Recovery After Surgery (ERAS) to help you arrive for surgery as healthy, strong, and prepared as possible.
1. Eat Well and Fuel your Body
In the days and weeks before surgery, focus on eating a healthy, balanced diet.
Include:
Protein
- Chicken, turkey, fish, lean meat
- Eggs
- Greek yogurt or cottage cheese
- Milk
- Beans and lentils
- Tofu or other plant-based proteins
Fruits and vegetables
- Aim for a variety of colorful fruits and vegetables each day.
Healthy carbohydrates
- Whole grains
A Simple goal
Include a good source of protein with every meal.
Protein helps support muscle health, strength, and tissue healing during recovery.
Do not begin a restrictive diet or attempt rapid weight loss immediately before surgery unless specifically recommended by your healthcare team.
- Oatmeal
- Rice
- Potatoes
- Whole-grain breads
Healthy fats
- Nuts
- Seeds
- Avocados
- Olive oil
2. Prioritize Protein
Surgery and recovery place increased demands on your body. Maintaining adequate protein intake can help support muscle mass and healing.
Try to include protein throughout the day:
- Breakfast: Eggs, Greek yogurt, cottage cheese, milk, or a protein-rich smoothie
- Lunch: Chicken, turkey, fish, lean meat, beans, or another protein source
- Dinner: Include a serving of lean protein with your meal
- Snacks: Greek yogurt, cottage cheese, cheese, nuts, milk, or a protein shake
If you have Concerns about your Nutrition
Please tell your surgical team if you have experienced:
- Poor appetite
- Unintentional weight loss
- Difficulty eating enough food
- Difficulty consuming adequate protein
- Significant dietary restrictions
3. Stay Well Hydrated
Good hydration is an important part of preparing for surgery.
During the days before surgery:
- Drink fluids regularly throughout the day.
- Water should be your primary source of hydration.
- Eat regular, balanced meals.
- Avoid becoming dehydrated.
- Avoid excessive alcohol consumption.
Do not intentionally restrict fluids before surgery unless specifically instructed to do so.
4. 12 Hours Before Surgery
Older instructions often required patients to stop eating and drinking at midnight before surgery. Modern ERAS principles emphasize avoiding unnecessarily prolonged fasting.
General Guidance for Many Elective Surgical Patients
Solid Food
Stop eating solid food 6 hours before anesthesia.
Your surgical and anesthesia teams may advise you to a longer time frame. (such as those on GLP1 agonist medications for weight loss which can require up to 24 hours of fasting prior to surgery)
Clear Liquids
Many patients may drink approved clear liquids until approximately 2 hours before anesthesia.
Examples of clear liquids may include:
- Water
- Clear apple juice
- Clear electrolyte beverages
- Tea without milk or cream
- Black coffee without milk or cream
Important
Your individualized anesthesia instructions always take priority over this handout.
5. PREOPERATIVE CARBOHYDRATE DRINKS
Carbohydrate loading is not necessary but an option for orthopaedic surgery patients.
An electrolyte + carbohydrate drink before surgery is an option unless you are on medications that restrict emptying of your stomach (such as GLP1 agonist medications).
These drinks may help:
- Reduce hunger and thirst before surgery
- Improve patient comfort
- Reduce some of the metabolic effects of prolonged fasting
- Possibly protect against muscle atrophy that can occur following surgery
Recommended drinks are clear, maltodextrin-based sugars with about 50 grams of total carbohydrates.
- When to drink it: Between 2-4 hours before your “show-time” to surgery
- How to drink it: Consume 10-12 ounces by sipping the drink steadily over a 5 to 10-minute period
- What to drink: 2 good options include:
- Ensure Pre-Surgery Clear Carbohydrate Drink
- Regular full-sugar Gatorade “Thirst Quencher”
- Do not use zero or low-calorie options
- Avoid Red and Purple versions (which can mimic blood in the stomach)
Important:
Carbohydrate drinks may not be appropriate for every patient.
Patients with certain medical conditions, including diabetes or conditions that affect stomach emptying must get clearance from the anesthesia service, or your surgery may be delayed or canceled.
6. Optimize your Body
Use the time before surgery to prepare your body for recovery.
Stay Active
Unless otherwise instructed:
- Continue regular physical activity.
- Maintain strength and mobility.
- Participate in physical therapy or prehabilitation if recommended.
- Avoid activities that significantly worsen your injury.
Prioritize Sleep
Aim for regular, adequate sleep in the days leading up to surgery.
Avoid Nicotine
Smoking and nicotine products may negatively affect:
- Wound healing
- Bone healing
- Tendon healing
- Infection risk
- Overall recovery
- Ability to manage and control pain
If you smoke, vape, or use nicotine products, please discuss cessation with your healthcare team. To optimize your healing and success of your surgery, it is recommended to cease nicotine 6 weeks prior and for 6-9 weeks following surgery.
Avoid Alcohol
Avoid alcohol before surgery and follow any additional instructions provided by your healthcare team.
Checklist: the Week before Surgery
DO
✓ Eat regular, balanced meals
✓ Include protein with every meal
✓ Stay well hydrated
✓ Continue appropriate physical activity
✓ Prioritize good sleep
✓ Follow medication instructions from your healthcare team
✓ Contact your surgical team if you become ill or develop new medical concerns
✓ Review your specific surgical and anesthesia instructions
Checklist: 24 Hours before Surgery
DO
✓ Eat normal, healthy meals unless instructed otherwise
✓ Include protein with your meals
✓ Drink fluids regularly throughout the day
✓ Follow medication instructions
✓ Prepare for your surgery and recovery at home
✓ Get a good night’s sleep
Do Not
✗ Drink alcohol
✗ Use nicotine products if instructed to stop before surgery
✗ Take medications or supplements that you have been instructed to discontinue
✗ Begin fasting earlier than instructed
Checklist: 6 Hours Before Surgery
Remember:
✓ Follow your specific fasting instructions
- Stop solid food 6 hours prior to surgery
- Stop clear liquids 2 hours prior to surgery
- Consider a 12-ounce carbohydrate clear liquid drink 6 and 2 hours prior to surgery
✓ Take only medications approved by your healthcare team
✓ Take medications with only the amount of water recommended by your anesthesia team
✓ Drink an approved ERAS carbohydrate beverage only if specifically instructed
✓ Arrive at your surgical facility at the scheduled time
Do Not
✗ Eat solid food after your instructed fasting time
✗ Drink fluids after your instructed cutoff time
✗ Chew gum or eat candy unless specifically approved
Checklist: Immediately After Surgery
Remember:
✓ Restart oral hydration as soon as able
- Carbohydrate drinks are appropriate
- Can progress to protein drinks as tolerated
✓ Progress to solid foods as soon as able
- Goal is 1.2 grams per kilogram of weight (20-40 grams per meal depending on body weight)
- Restart healthy balanced diet as noted on the pre-surgery recommendations in this handout
✓ Supplements—You may consider the following supplements to ensure healing and boost recovery:
- Essential Amino Acids (key AA’s: Leucine, Arginine, Glutamine)
- Vitamin C (500 mg) +/- 10-20 grams/day of hydrolyzed oral Collagen
- Vitamins A, D, and Zinc
