NUTRITIONAL PREHABILITATION AND POST-OPERATIVE NUTRITIONAL SUPPORT FOR PAIN REDUCTION AND ENHANCED RECOVERY: A NURSE-NUTRITIONIST PROTOCOL FOR ITALIAN COMMUNITY SURGICAL PATIENTS

G. Fedelfranco¹, N. Misceo² | ¹Social Health Local District · ASL Bari · U.O. Port of Unique Access /Multidimensional Evaluation Unit, DiMePReJ – University of Bari "Aldo Moro", Bari, Italy; ²Ministry of Health, SASN Bari, Italy

Background & Aims. Nutritional prehabilitation - optimising nutritional status before surgery - and structured post-operative nutritional support are cornerstones of ERAS (Enhanced Recovery After Surgery) protocols, demonstrably reducing post-operative pain, opioid consumption, and length of stay. Despite ERAS widespread hospital adoption, community-based nutritional management of post-operative pain patients, including those re-integrated via DOP Protected Discharge pathways, is absent from Italian territorial care protocols. This study aims to: (1) assess nutritional status (NRS-2002, anthropometry, BIA) in pre-surgical patients referrednto ASL Bari community care before elective procedures; (2) implement and evaluate a 4-week pre-operative Prehabilitation Nutrition Protocol (PrehabNP) + 6-week post-operative Community Nutrition Support (CNS); (3) measure impact on post-operative pain (NRS), opioid consumption (morphine equivalent daily dose, MEDD), andwound healing (PUSH score).
Methods. Design: Prospective quasi-experimental cohort (PrehabNP+CNS vs standard care). Setting: Community Social Health Local District nutritionist + surgical ward DOP interface, 2025–2026 (N=80; N=40 PrehabNP+CNS, N=40 control). PrehabNP: hypercaloric (35 kcal/kg/day), hyperproteic (1.5g/kg/day), arginine 9g/day, omega-3 2g/day, 4 weeks pre-op. CNS: oral nutritional supplement (1.5 kcal/mL protein-enriched) + micronutrient support 6 weeks post-op. Process instruments: NCP SIAP module, ERAS nutrition checklist, PUSH score, MEDD log. Change management: PDSA + CFIR. Statistics: ANCOVA (NRS, MEDD at day 30, adjusted for baseline).
Results. (Prelim.) Baseline data (N=44 enrolled): NRS-2002 ≥3 in 43.2% (N=19). Mean albumin 3.4 g/dL. Phase angle BIA <4.5° in 38.6% (N=17). PrehabNP+CNS 6-week interim (N=18 intervention): Post-operative NRS at day 7: 3.1 vs 5.2 control (p=0.001). MEDD at day 7: 24.3mg vs 38.7mg (p=0.009). PUSH score: 88.9% healing response vs 61.1% control (p=0.043). Hospital readmission: 5.6% vs 22.2% (p=0.08, underpowered).
Conclusions. Pre-operative nutritional prehabilitation combined with structured community nutritional support significantly reduces post-operative pain intensity and opioid consumption in Italian surgical patients managed through the DOP pathway. The PrehabNP+CNS protocol, integrated into ERAS-aligned community care via NCP documentation and CFIR-guided change management, represents a high-impact, scalable nutritional quality improvement model.