Perioperative Surgical Home Concept


It is normal to feel nervous before any type of surgical procedure and Anesthesia is one of the major reasons why. What if you – regardless of type of surgery or surgical setting – could speak with an anesthesiologist before your scheduled surgery? What if that anesthesiologist could help maximize your results and reduce risks, while also alleviating your anxiety? Having a pre-surgical consult with a staff anesthesiologist before your procedure can do just that.

Perioperative Surgical Home Concept Right Column Photo

Surgery is a major undertaking much like running a marathon or climbing a mountain. People train for these activities – they diet, exercise, supplement themselves with vitamins and talk to the best coaches. Shouldn’t your surgical and anesthetic preparation be like that of an elite athlete?



It is the perioperative surgical home concept. For years hospitals, insurance companies, and healthcare providers have looked for ways to improve their patients’ results. They focused on getting patients out of surgery and the hospital faster, more efficiently, and with less complications. However, the vast majority of these initiatives have focused on what happens to patients once they are in the hospital, undergoing surgery or receiving an anesthetic. No one has really focused on the patient, as an individual, BEFORE they come to surgery. Surgery is a major undertaking, akin to running a marathon or climbing a mountain. People train for these activities-they diet, they exercise, supplement themselves with oral and infused vitamins and they talk to the best coaches. Why shouldn’t a patient’s overall wellness and their surgical and anesthetic preparation be treated like training for an elite competition. The “POSH” theory is elite training for the “competition” of surgery.


All clients can expect:

  • Medical consultation with a Board Certified Anesthesiologist .
  • Full medical history and physical review.
  • 7-day pre-operative diet if desired.
  • Immunity and Vitamin Boosting infusion the week prior to surgery.
  • Option to return for post-operative care, stabilization and optimization of post-surgical results.

All the staff are super friendly and definitely care about all of Dr. Zelken's patients.

–Christiana C.


Vitamin E and surgery do not mix because Vitamin E is associated with increased bleeding, and this can lead to collection of blood (called a hematoma) that could result in serious complications. Most surgeons will instruct you to avoid preparations with Vitamin E before surgery, however, so it is important to check your dietary supplements/multivitamin carefully. However, after the surgery, your health care professional may indicate that Vitamin E may be appropriate. Most people are confused when they are instructed to avoid Vitamin E prior to surgery because topical Vitamin E is often associated with of healing scars. Several commonly taken herbal supplements to avoid are: Ginko Biloba, Garlic, Ginseng, Ginger, Dong Quai, Ephedra, Feverfew, St. John’s Wort, Omega 3 fatty acids/large doses of fish oil all of which have anticoagulant effects.


Patients in the care of the Zelken Institute of Aesthetic Medicine for their surgery can also expect privileged access to our staff anesthesiologist and courtesy pricing for POSH.


What are the short term and long-term benefits of POSH?

The benefits of POSH include, but are not limited to, improved wound healing, decreased scarring, decreased recovery time, improvement in overall results and creating a foundation for lasting changes that continue to improve the patient’s overall quality of life, not just their post-surgical course. We will work to create a customized, physician designed plan for the weeks before surgery and provide easy to follow recommendations for the days and weeks after surgery that will speed your recovery and give you a strong foundation for building on your overall wellness during your recovery period. If you are having an Aesthetic procedure with Dr. Zelken, an additional benefit is that your intraoperative anesthetic will be discussed well before your surgery and we will use the latest ERAS (Enhanced Recovery After Surgery) protocols, thorough pre, and intra-operative warming and a variety of different pain relief and anti-nausea modalities to make your experience not only safe but extremely comfortable. We will then offer you a program to guide your nutrition and supplementation during your recovery period and follow up with you regularly to ensure that you have the resources to maximize your recovery.

Why is nutrition so important?

The American College of Surgeons states that "Nutritional status is a major determinant of outcomes for any type of surgery." That is because any surgery generates a strong systemic inflammatory response, creates a catabolic stress on the body, depletes nutrients and causes an increased oxygen and ATP requirement. Increased oxygen consumption means that less is available for peripheral tissues and wound healing. In addition, surgical injury can interrupt blood flow and the delivery of not only oxygen but nutrients need for tissue healing and regeneration.

David Evans, MD, of The Ohio State University, a noted supporter of both pre- and post-surgical nutritional management, stated at the 2014 Academy of Nutrition and Dietetics' Food & Nutrition Conference, "Traditional beliefs still persist among surgeons to delay initiating nutrition support, despite recommendations to the contrary." He was referring to what we now know as ERAS or the "enhanced recovery of patient after surgery. He endorses preoperative nutrition assessments and counseling; prebiotic/probiotics administration; limiting preoperative fasting to two to three hours, rather than the traditional six to 12 hours; and immediate postoperative fluid and diet initiation along with activity.

What kind of pre, and post-operative wellness therapy should a surgical patient at the Zelken Institute expect?

At the Zelken Institute for Aesthetic Medicine we take your surgical preparation, whether it is for surgery here or at another hospital or surgery center, to an unprecedented level. We seek to use an evidence based, scientific approach that is easy to follow and overseen by an Anesthesiologist with over a decade of experience caring for patients in the pre, intra and post operatively setting. Our version of perioperative surgical home is built around the premise that regardless of where your surgery is taking place optimizing your nutrition, exercise and supplementation in the weeks before surgery will improve your post-surgical experience, results and recovery. Then, we provide our patients with easy to implement recommendations for post-operative nutritional and supplementation can be followed independently or you can choose to return to the Zelken Institute For Aesthetic Medicine for a customized physician guided approach to your post-surgical recovery.

What exactly is POSH therapy?

Patient evaluation for POSH therapy includes several modalities. A comprehensive medical and anesthetic history is required to evaluate the patient. Confirmation that all proper pre-surgical testing has been performed (cardiology, pulmonary, endocrinology etc. related to previous medical or surgical issues) will help to reduce the likelihood that a patient has their surgery cancelled on the day of surgery, regardless of where their surgery is taking place. Our patients receive a thorough whole-body examination that allows us to evaluate our patients at an entirely new level. With that one simple scan we can tailor our patient’s nutrition and hydration and even evaluate the impact of our therapies over time. While pre-surgical labs are common we have unique specialty laboratory that allows us to measure our patients exact nutritional needs along with their oxidative stress levels. We can then use those results to help create a supplementation plan that is customized and unique to each patient’s needs. Consistent personal follow up and access to our staff anesthesiologist will help to alleviate patient concerns, reduce stress and make the experience of undergoing surgery and anesthesia much more pleasant.

How much does POSH therapy cost?

The cost of a comprehensive pre-operative surgical evaluation is $599. Additional costs may be incurred for laboratory testing and for customized supplementation programs. The cost covers services provided for a one month period encompassing 2 weeks before your surgery and 2 weeks of recommendations for the post-surgical recovery period. After that, many of the tools you have been provided and the dietary steps you have learned can be applied to improving your overall wellness or you can choose to return to our Wellness Institute for further specialized guidance. A free application for the iPhone will make communicating with our medical staff easy and HIPAA (Health Insurance Portability and Accountability Act of 1996) compliant. Using this app documents, laboratory information and text messages can be readily exchanged and questions can be answered throughout the process.

What are some of the facets of the POSH that make it valuable?

It is the comprehensive, evidence based, multifaceted approach that makes this unique form of patient preparation so valuable. In the United States, over 50 million procedures are performed annually on an outpatient basis. Most outpatient surgery is accounted for by free-standing surgi-centers and between 1996 and 2006 there was a 300 % increase in procedures at these centers, while hospital based ambulatory surgery numbers remained relatively unchanged. At the Zelken Institute for Aesthetic Medicine your wellness and pre-surgical preparation is guided by an M.D. with extensive experience in both areas. That expertise has been used to create a unique suite of tools to individualize and guide your care. This includes the pre-surgical evaluation. It ends with the peace of mind of knowing that you will be followed through the entire course of your surgical experience and can ask questions of your personalized guide, throughout.

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