A guide to help you bring your healthiest, best-prepared self to the operating room
Most shoulder surgeries — including operations for arthritis, rotator cuff problems, and instability — are elective. Because they are planned, you have an opportunity that emergency patients do not: the chance to arrive in the operating room as healthy and as well prepared as possible. The recommendations below are meant to help. Please review them with your surgeon and primary care provider, who can tailor them to you.
Why Nutrition Matters Before and After Surgery
Many people come to surgery relatively undernourished, often without realizing it. This is true even for patients who are not underweight — a person can carry plenty of weight and still be short on the protein, vitamins, and other building blocks that healing depends on.
Surgery places an added demand on your metabolism. To rebuild tissue, fight off infection, and regain strength, your body burns through more protein, calories, vitamins, and fluid than usual. If you begin in a depleted state, you have less in reserve at exactly the moment your body needs the most.
For that reason, the goal is to get a head start before surgery and keep it going afterward. Think of it the way an athlete fuels for an event: you want to go in well-stocked rather than running on empty, and you want to keep refueling throughout your recovery. The diet, protein, and supplement suggestions in this handout are aimed at exactly that.
A Word About Fasting Before Surgery
You will be told to stop eating and drinking for a period before your operation. This is an important safety measure for anesthesia. The traditional instruction — “nothing to eat or drink after midnight” — can be surprisingly hard on your body, however, especially if your surgery is scheduled for the afternoon. A midnight cutoff before a mid-afternoon operation can mean 14 hours or more with no food or fluid. That comes close to a starvation state at the very time your body is preparing for the stress of surgery.
Modern anesthesia guidelines are generally more flexible than the old midnight rule. In many practices, solid food is stopped roughly 6 to 8 hours before surgery, while clear liquids — water, apple juice, black coffee or tea, or a clear sports drink — are allowed up to 2 hours before. Some programs even encourage a special clear carbohydrate drink a couple of hours beforehand to ease hunger and thirst and to lessen the metabolic stress of fasting.
Important: Fasting instructions differ from patient to patient and from one facility to another. Always follow the specific instructions given by your surgeon and anesthesia team, and ask them directly when you should stop (1) eating solid food and (2) drinking clear liquids. If you eat or drink against these instructions, your surgery may have to be delayed or cancelled on the day of the operation, so it is important to get the timing right.
A Note About GLP-1 Medications (Ozempic, Wegovy, Mounjaro, and Similar Drugs)
A growing number of people take a class of medication called GLP-1 receptor agonists — used for type 2 diabetes and for weight management. Common ones include semaglutide (Ozempic, Wegovy), tirzepatide (Mounjaro, Zepbound), liraglutide (Victoza, Saxenda), and dulaglutide (Trulicity). They may be given as a daily or a once-weekly injection, or as a daily pill.
These medications matter for surgery because they slow down how quickly your stomach empties. That means your stomach may still hold food or liquid even after the usual fasting period — which can raise the risk of stomach contents coming back up and entering the lungs while you are under anesthesia. For that reason, your care team needs to know if you take one of these drugs.
What to do:
They may ask you to hold a dose before surgery. For a once-weekly injection this often means skipping the dose during the week of your operation; for a daily form, it may mean the day of surgery. Some teams also ask you to take only clear liquids the day before.
Do not stop the medication on your own, especially if you take it for diabetes — stopping without a plan can worsen your blood sugar control. Coordinate the timing with the provider who manages the medication.
Recommendations in this area are still evolving and vary from one practice to another, so the most important step is simply to raise it early and follow the specific instructions your surgeon and anesthesia team give you.
At the University of Washington the following rule applies: for any patient having taken GLP-1 Medications within 5 weeks of their surgery, no foods other than clear liquids are allowed for 24 hours prior to surgery.
Confirm the plan well in advance and make sure you understand exactly what to do. If you arrive for surgery without having followed these instructions, your operation may be delayed or cancelled that day for your safety — so it is well worth getting the details right ahead of time.
Nutritional Supplement Drinks (such as Ensure Plus)
If you have trouble eating enough, or simply want an easy way to raise your protein and calorie intake before and after surgery, oral nutrition drinks can help. Products such as Ensure Plus, Boost Plus, or their less-expensive store-brand equivalents are calorie- and protein-dense and need no preparation. An 8-ounce serving of Ensure Plus provides roughly 350 calories and about 13 grams of protein, along with added vitamins and minerals.
Consider taking one to three of these per day in the days and weeks leading up to surgery to build your reserves, then resuming them afterward to help meet the added demands of healing — especially in the first days, when appetite is often low.
One important caution: these drinks are milk-based and are not clear liquids. For fasting purposes they count as food and must be stopped on the same schedule as solid meals (typically 6 to 8 hours before surgery) — not during the 2-hour clear-liquid window. If your surgeon wants you to have something closer to surgery, he or she will recommend a specific clear carbohydrate drink. When in doubt, ask.
Your Pre-Surgery Checklist
A. Get Comfortable with the Surgery and Recovery
Discuss the following with your surgeon:
The planned procedure, including its likely benefits and possible risks
Surgical and non-operative treatment options
The recovery process, including post-surgery do’s and don’ts
Any special equipment you will need after surgery
The timing and frequency of postoperative visits, including when your bandage will be changed and your sutures removed
Whether you will need physical therapy
If you need other procedures — for example on your hands, feet, knees, or hips — the ideal order in which to have them
B. Assemble Your Support Team
Make sure you have help in place for your recovery. Ask your surgeon what kind of support you will need and for how long — for example, how soon after surgery you will be able to drive a car.
If you live alone, this is especially important. Arrange help ahead of time from family, friends, or hired caregivers, and put it on the calendar before your surgery rather than trying to organize it afterward. Plan in particular for the first days at home, when you will need the most assistance with dressing, meals, and getting around.
Some patients understandably assume that Medicare routinely covers in-home physical therapy or home health aides after surgery. In most cases, this is not covered unless the patient meets criteria such as being functionally homebound.
For the majority of elective surgical patients, the support system they have in place before surgery should be considered their primary post-operative plan.
That said, some Medicare Advantage or supplemental plans may offer additional home health benefits. Patients should contact their insurance plan directly to confirm what, if any, benefits are available. These services are coverage-dependent and should not be assumed as part of the surgical planning process.
C. Confirm Insurance Authorization
Make sure the procedure is authorized by your insurance company and that both the hospital and surgeon fees will be covered.
D. Complete Pre-Surgery Requirements
Finish all required tests, imaging, and consultations well in advance.
E. Understand Medication Management
Ask both your surgeon and your primary care provider which medications to stop before surgery and exactly when to stop them. Blood thinners, diabetes medications, and certain supplements often need special attention. GLP-1 medications (Ozempic, Wegovy, Mounjaro, and similar drugs) deserve particular attention— see “A Note About GLP-1 Medications” above — so be sure to mention them by name.
F. Know Your Fasting Requirements
Confirm when to stop (1) eating solid food and (2) drinking clear liquids before surgery. See “A Word About Fasting Before Surgery” above — and remember that nutritional supplement drinks count as food, not clear liquids.
G. Discuss Pain Management
Review the plan for managing pain after surgery and confirm who will manage your pain medications.
If you already take narcotic (opioid) pain medication, do not stop on your own. Make a plan in advance with a medical provider who has agreed to continue managing these medications through your surgery and recovery, so that your pain is controlled safely and without a gap in care.
Some surgeons use nerve blocks for postoperative pain control, while others do not. If this is something of interest to you, be sure to discuss it with your surgeon well before your surgical date so arrangements can be made if necessary.
H. Plan for Daily Activities and Mobility
Talk through how the surgery will affect everyday tasks — getting out of bed and chair, dressing, bathing, and getting around — and plan ahead for each one.
Clothing. Set aside a wardrobe you can manage without using your surgical arm: loose, front-opening or button-up tops rather than pullovers, and slip-on shoes, so you can get dressed and put on shoes without raising or reaching with that arm.
Driving. For many shoulder operations you should not drive for up to six weeks. Plan transportation ahead of time — for the ride home after surgery and for later appointments and errands — and confirm the timeline with your surgeon.
Showering. Plan for safe showering. Follow your surgeon’s instructions for keeping the incision and dressing dry, and consider a non-slip mat, a grab bar, a shower chair, and a handheld showerhead. Have someone available to help, especially the first few times.
I. Optimize Your Health
Weight. Body mass index (BMI) is a useful indicator of your height-to-weight balance. To estimate it, divide your weight in pounds by your height in inches squared, then multiply by 703. For most people, a BMI in the range of roughly 20 to 30 is a reasonable target going into surgery, with risk tending to rise at both ends of the scale. A BMI of 40 or above may indicate severe obesity, which can raise the rate of complications. Just as important — and often overlooked — a low BMI (below about 19 to 20) can signal undernutrition and a lack of the reserves your body draws on to heal; in many surgical studies, being underweight is associated with poorer wound healing and higher complication rates. The goal is not to be as thin as possible, but to arrive well-nourished and strong. If you have lost weight recently — including intentional weight loss on a GLP-1 medication (see above) — let your surgeon know, since your current weight and nutritional reserves may differ from what your records show.
Diet.
Aim for balanced nutrition with adequate protein, fruits, and vegetables. To support healing, a daily protein intake of about 0.5 gram per pound of body weight is often recommended; confirm what is right for you with your provider.
Nutritional supplement drinks (see the section above) are an easy way to reach your protein and calorie goals before and after surgery.
If you do not care for meat or fish, whey protein powder — mixed into milk, water, or a smoothie — is an inexpensive, convenient way to reach your daily protein goal.
Ask your provider about vitamin D and C supplements; both are important for healing, and many people are deficient in them.
Stay well hydrated. A common guideline is 0.5 to 1 ounce of fluid per pound of body weight per day.
Habits.
Reduce or eliminate alcohol; it raises surgical risk and complicates pain management. In most cases it should be stopped at least two weeks before surgery.
Stop smoking and using nicotine products at least one month before surgery. Smoking dramatically increases surgical risk and the rate of complications, including problems with wound and bone healing.
Reduce or eliminate narcotic (opioid) pain medication for two weeks before surgery, as ongoing use complicates pain control afterward. If you take opioids regularly, do not stop on your own — coordinate a plan with your provider (see “Discuss Pain Management” above).
Fall Prevention. Make your home safe before surgery: provide good lighting throughout, especially on stairs and along the path to the bathroom; remove obstacles such as clutter, loose rugs, and electrical cords; and install sturdy railings on stairs and grab bars where they help. Keep your vision well corrected and practice your balance.
Exercise. Aim for at least 30 minutes of activity each day. Walking is ideal, and simple strengthening such as step-ups or arm curls adds to the benefit. Keeping up regular cardio, strength, and flexibility work in the weeks before surgery — sometimes called “prehabilitation” — can speed your recovery.
Manage Chronic Conditions. Optimize your blood sugar, blood pressure, lung function, and bone health. If you have diabetes or prediabetes, an A1C below 7 is often recommended before surgery.
Medications. Continue your regular medications until you are advised to stop them.
Rest. Get adequate sleep and rest in the weeks leading up to surgery.
Skin Health. Address any skin problems. Poor skin condition or open sores may delay surgery until they have healed.
Dental Health. Manage dental issues proactively. Root canals, necessary gum surgery, and infections should be taken care of before your operation.
These general guidelines can improve both the safety of your surgery and the quality of your recovery. They are a starting point for conversation, not a substitute for the advice of your own care team — please review them with your surgeon and primary care provider.
