1. PAT: Surgical Readiness
Figure 1*; supplemental digital content files for online publication only
Surgical Oncology
Ortho
Spine
Vascular
POET
Diabetes
Nutrition
Smoking Cessation
POSH
Pain
Anemia
High Risk OB
Ortho
Spine
Vascular
Vascular
PAT: Surgical Readiness
POET and Pre-op Hub-and-Spoke Model; Cross referrals between programs
Surgical Oncology
Ortho
Spine
Vascular
Surgical Oncology
Spine

2. Figure 2*;
supplemental digital content files for online publication only

3. Figure 3*;
supplemental digital content files for online publication only

4. Preoperative Nutrition Clinic
Figure 4*: supplemental digital content files for online publication only
BMI Score
Weight loss score
Intake score
BMI < 18.5
(<20 if age >65)
Eating < 50% in preceding week normal diet
Unplanned weight loss > 10% in past 6 months
Any Yes Answers
AND/OR
Albumin < 3.0
Vitamin D < 20
Preoperative Nutrition Clinic

5. Preoperative Nutrition Clinic
Figure 5*; supplemental digital content files for online publication only
SURGERY
Oral IMN 7 d post-op
Decision for Surgery
PONS (-)
PAT
Oral IMN 5 d pre-op
Low Risk
PONS
PONS (+)
High Risk
Weight Gain or Stabilized, ↑ALB trend,
Improved Nutrition Assessment
Preoperative Nutrition Clinic
Nutrition - history/physical
Education on for home PO intake
ONS/EN/TPN recommendation
Continue Nutrition Therapy
Reassess Weekly
Consider Surgery Delay
Continue ONS/EN/TPN
Check Compliance
Consider other weight loss etiologies (i.e. ↑tumor burden/infection)
Communicate w/ Primary Surgeon
Weekly Calls / Telehealth
PO intake evaluation
Weight evaluation
Continue ONS/EN/TPN
Check Compliance
Continued Weight Loss, Evidence. of Worsening Nutrition Status 
1 Month Reassessment
Alb /Weight / Nutrition-H/P
Continue ONS/EN/TPN
Check Compliance

6. POST-operative Chronic pain service PRE-operative pain clinic
Decision for Surgery
Low
risk
Transition of care to
PCP
Up to 90 days
Surgery
PAT/PASS
ongoing support
& management
In patient
pain service
High
risk
1 -3 month
POST-operative Chronic pain service
intervention
& optimization
PRE-operative pain clinic
Figure 6*; supplemental digital content files for online publication only