Why Nutrition Before Surgery Matters

At Pre-Op™, we believe healing starts long before the first incision. As surgeons, we’ve seen how preoperative nutrition can directly impact wound healing, recovery time, and complication rates. That’s why we formulated Pre-Op™ with clinically studied nutrients that support your body’s natural healing mechanisms—starting weeks before surgery.

Key Ingredients:

Collagen Peptides (3,000 mg)

The body’s primary structural protein, essential for wound healing and tissue repair. Supplementation helps provide the building blocks (glycine, proline, hydroxyproline) needed to restore connective tissue.

L-Arginine (2,000 mg)

A conditionally essential amino acid shown to support immune function, collagen production, and blood flow. Clinically used in immunonutrition to reduce postoperative infections.

Vitamin C (500 mg)

A powerful antioxidant critical for collagen synthesis and immune support. Also shown to reduce the incidence of postoperative infections and support soft tissue repair.

Zinc (25 mg, as gluconate)

Crucial for DNA synthesis, cell proliferation, and immune function. Zinc deficiency is strongly associated with delayed wound healing and higher infection risk.

Calcium (250 mg, as citrate or carbonate)

Supports bone mineralization and is essential for successful fusion and fracture healing. Pairs synergistically with vitamin D3.

Magnesium (150 mg, as citrate or oxide)

A cofactor in over 300 enzymatic reactions including those related to protein synthesis, nerve function, and bone metabolism. Supports both wound healing and bone recovery.

Folate (400 mcg DFE, as 5-MTHF)

A B-vitamin critical for cell division, DNA synthesis, and tissue regeneration. Especially important in high-turnover states like wound healing.

Vitamin B12 (250 mcg, as methylcobalamin)

Supports red blood cell formation, DNA synthesis, and neurological recovery. Synergistic with folate for cellular repair.

Vitamin D3 (1,000 IU / 25 mcg)

Well-established role in bone healing and immune regulation. Deficiency is common in surgical patients and associated with delayed fusion and infection risk.

Vitamin A (900 mcg RAE / 3,000 IU)

Essential for epithelial integrity, immune function, and soft tissue healing. Plays a vital role in minimizing wound breakdown and infection.

Clinically Informed, Surgeon Formulated
Each ingredient in Pre-Op™ is backed by peer-reviewed evidence. We’ve designed the formulation to match published protocols used in enhanced recovery after surgery (ERAS) guidelines.

    Pre-Op™ Supplement Evidence Library

    This document contains a comprehensive list of peer-reviewed references supporting the inclusion of each nutrient in the Pre-Op™ surgical support formula.

    Collagen Peptides Evidence

    1. Cummings KC, Keshock M, Ganesh R, et al. Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clinic Proceedings. 2021;96(5):1342-1355. doi:10.1016/j.mayocp.2020.08.016.
    2. Tang X, Reidlinger DP, Crichton M, et al. Preoperative Micronutrient Repletion Strategies in Metabolic and Bariatric Surgery: A Systematic Review. Journal of the Academy of Nutrition and Dietetics. 2024;:S2212-2672(24)00864-5. doi:10.1016/j.jand.2024.09.007.
    3. Heutlinger O, Acharya N, Tedesco A, et al. Nutritional Optimization of the Surgical Patient: A Narrative Review. Advances in Nutrition (Bethesda, Md.). 2025;16(1):100351. doi:10.1016/j.advnut.2024.100351.

    L-Arginine Evidence

    1. Ricci C, Serbassi F, Alberici L, et al. Immunonutrition in Patients Who Underwent Major Abdominal Surgery: A Comprehensive Systematic Review and Component Network Metanalysis Using GRADE and CINeMA Approaches. Surgery. 2023;174(6):1401-1409. doi:10.1016/j.surg.2023.08.005.
    2. Khaleel S, Regmi S, Hannah P, et al. Impact of Preoperative Immunonutrition on Perioperative Outcomes Following Cystectomy. The Journal of Urology. 2021;206(5):1132-1138. doi:10.1097/JU.0000000000001945.
    3. Angka L, Martel AB, Ng J, et al. A Translational Randomized Trial of Perioperative Arginine Immunonutrition on Natural Killer Cell Function in Colorectal Cancer Surgery Patients. Annals of Surgical Oncology. 2022;29(12):7410-7420. doi:10.1245/s10434-022-12202-y.
    4. Matsui R, Sagawa M, Sano A, et al. Impact of Perioperative Immunonutrition on Postoperative Outcomes for Patients Undergoing Head and Neck or Gastrointestinal Cancer Surgeries: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Annals of Surgery. 2024;279(3):419-428. doi:10.1097/SLA.0000000000006116.
    5. Braga M, Wischmeyer PE, Drover J, Heyland DK. Clinical Evidence for Pharmaconutrition in Major Elective Surgery. JPEN. Journal of Parenteral and Enteral Nutrition. 2013;37(5 Suppl):66S-72S. doi:10.1177/0148607113494406.
    6. Irani JL, Hedrick TL, Miller TE, et al. Clinical Practice Guidelines for Enhanced Recovery After Colon and Rectal Surgery From the American Society of Colon and Rectal Surgeons and the Society of American Gastrointestinal and Endoscopic Surgeons. Diseases of the Colon and Rectum. 2023;66(1):15-40. doi:10.1097/DCR.0000000000002650.
    7. Rosenthal MD, Carrott PW, Patel J, Kiraly L, Martindale RG. Parenteral or Enteral Arginine Supplementation Safety and Efficacy. The Journal of Nutrition. 2016;146(12):2594S-2600S. doi:10.3945/jn.115.228544.
    8. Evans DC, Martindale RG, Kiraly LN, Jones CM. Nutrition Optimization Prior to Surgery. Nutrition in Clinical Practice. 2014;29(1):10-21. doi:10.1177/0884533613517006.
    9. Vidal-Casariego A, Calleja-Fernández A, Villar-Taibo R, Kyriakos G, Ballesteros-Pomar MD. Efficacy of Arginine-Enriched Enteral Formulas in the Reduction of Surgical Complications in Head and Neck Cancer: A Systematic Review and Meta-Analysis. Clinical Nutrition. 2014;33(6):951-7. doi:10.1016/j.clnu.2014.04.020.
    10. Braga M. Perioperative Immunonutrition and Gut Function. Current Opinion in Clinical Nutrition and Metabolic Care. 2012;15(5):485-8. doi:10.1097/MCO.0b013e3283567d8f.

    Vitamin C Evidence

    1. Suter M, Bollen Pinto B, Belletti A, Putzu A. Efficacy and Safety of Perioperative Vitamin C in Patients Undergoing Noncardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Trials. British Journal of Anaesthesia. 2022;128(4):664-678. doi:10.1016/j.bja.2021.11.039.
    2. Fukushima R, Yamazaki E. Vitamin C Requirement in Surgical Patients. Current Opinion in Clinical Nutrition and Metabolic Care. 2010;13(6):669-676. doi:10.1097/MCO.0b013e32833e05bc.
    3. Tang X, Reidlinger DP, Crichton M, et al. Preoperative Micronutrient Repletion Strategies in Metabolic and Bariatric Surgery: A Systematic Review. Journal of the Academy of Nutrition and Dietetics. 2024;:S2212-2672(24)00864-5. doi:10.1016/j.jand.2024.09.007.
    4. Oudemans-van Straaten HM, Spoelstra-de Man AM, de Waard MC. Vitamin C Revisited. Critical Care (London, England). 2014;18(4):460. doi:10.1186/s13054-014-0460-x.
    5. Hill A, Clasen KC, Wendt S, et al. Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis. Nutrients. 2019;11(9):E2103. doi:10.3390/nu11092103.
    6. Karadžić Kočica M, Ristić A, Soldatović I, et al. The Influence of High-Dose Parenteral Vitamin C on the Incidence and Severity of Postoperative Pulmonary Complications in Cardiac Surgery With Extracorporeal Circulation: A Randomized Controlled Trial. Nutrients. 2024;16(6):761. doi:10.3390/nu16060761.
    7. Cummings KC, Keshock M, Ganesh R, et al. Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clinic Proceedings. 2021;96(5):1342-1355. doi:10.1016/j.mayocp.2020.08.016.
    8. Chen S, Roffey DM, Dion CA, Arab A, Wai EK. Effect of Perioperative Vitamin C Supplementation on Postoperative Pain and the Incidence of Chronic Regional Pain Syndrome: A Systematic Review and Meta-Analysis. The Clinical Journal of Pain. 2016;32(2):179-185. doi:10.1097/AJP.0000000000000218.
    9. Travica N, Ried K, Hudson I, et al. The Effects of Surgery on Plasma/Serum Vitamin C Concentrations: A Systematic Review and Meta-Analysis. The British Journal of Nutrition. 2022;127(2):233-247. doi:10.1017/S0007114520004353.

    Zinc Evidence

    1. Vidal-Casariego A, Calleja-Fernández A, Villar-Taibo R, et al. Efficacy of Arginine-Enriched Enteral Formulas in Surgical Complications in Head and Neck Cancer: A Meta-Analysis. Clin Nutr. 2014;33(6):951-957. doi:10.1016/j.clnu.2014.04.020.
    2. Rosenthal MD, Carrott PW, Patel J, et al. Parenteral or Enteral Arginine Supplementation Safety and Efficacy. J Nutr. 2016;146(12):2594S-2600S. doi:10.3945/jn.115.228544.
    3. McClave SA, DiBaise JK, Mullin GE, et al. ACG Clinical Guideline: Nutrition Therapy in the Adult Hospitalized Patient. Am J Gastroenterol. 2016;111(3):315-334. doi:10.1038/ajg.2016.28.

    Calcium Evidence

    1. Sittitrai P, Ruenmarkkaew D, Klibngern H, et al. Perioperative Versus Postoperative Calcium and Vitamin D Supplementation to Prevent Symptomatic Hypocalcemia After Total Thyroidectomy: A Randomized Placebo Controlled Trial. International Journal of Surgery. 2023;109(1):13-20. doi:10.1097/JS9.0000000000000192.
    2. Khatiwada AS, Harris AS. Use of Pre-Operative Calcium and Vitamin D Supplementation to Prevent Post-Operative Hypocalcaemia in Patients Undergoing Thyroidectomy: A Systematic Review. The Journal of Laryngology and Otology. 2021;135(7):568-573. doi:10.1017/S0022215121001523.
    3. Casey C, Hopkins D. The Role of Preoperative Vitamin D and Calcium in Preventing Post-Thyroidectomy Hypocalcaemia: A Systematic Review. European Archives of Oto-Rhino-Laryngology. 2023;280(4):1555-1563. doi:10.1007/s00405-022-07791-z.
    4. Li D, Tian M, Zhang Y, et al. Preoperative Supplementation of Calcitriol and Calcium Relieves Symptom and Extent of Hypocalcemia in Patients Undergoing Total Thyroidectomy and Bilateral Central Compartment Neck Dissection: A Prospective, Randomized, Open-Label, Parallel-Controlled Clinical Study. Frontiers in Oncology. 2022;12:967451. doi:10.3389/fonc.2022.967451.
    5. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid. 2018;28(7):830-841. doi:10.1089/thy.2017.0309.
    6. Donahue C, Pantel HJ, Yarlagadda BB, Brams D. Does Preoperative Calcium and Calcitriol Decrease Rates of Post-Thyroidectomy Hypocalcemia? A Randomized Clinical Trial. Journal of the American College of Surgeons. 2021;232(6):848-854. doi:10.1016/j.jamcollsurg.2021.01.016.
    7. Maxwell AK, Shonka DC, Robinson DJ, Levine PA. Association of Preoperative Calcium and Calcitriol Therapy With Postoperative Hypocalcemia After Total Thyroidectomy. JAMA Otolaryngology--Head & Neck Surgery. 2017;143(7):679-684. doi:10.1001/jamaoto.2016.4796.
    8. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. doi:10.1089/thy.2016.0229.
    9. Jullamusi W, Ratanaprasert N, Pongsapich W, Kasemsuk N. Preoperative Calcium or Vitamin D Supplement in Thyroidectomy: A Systematic Review and Meta-Analysis. The Laryngoscope. 2025;135(4):1267-1277. doi:10.1002/lary.31860.
    10. Sanabria A, Rojas A, Arevalo J. Meta-Analysis of Routine Calcium/Vitamin D3 Supplementation Versus Serum Calcium Level-Based Strategy to Prevent Postoperative Hypocalcaemia After Thyroidectomy. The British Journal of Surgery. 2019;106(9):1126-1137. doi:10.1002/bjs.11216.

    Magnesium Evidence

    1. Tohme J, Sleilaty G, Jabbour K, et al. Preoperative Oral Magnesium Loading to Prevent Postoperative Atrial Fibrillation Following Coronary Surgery: A Prospective Randomized Controlled Trial. European Journal of Cardio-Thoracic Surgery. 2022;62(5):ezac269. doi:10.1093/ejcts/ezac269.
    2. Hung KC, Chang LC, Ho CN, et al. Influence of Intravenous Magnesium Sulfate Infusion on the Subjective Postoperative Quality of Recovery: A Meta-Analysis of Randomized Controlled Trials. Nutrients. 2024;16(14):2375. doi:10.3390/nu16142375.
    3. Oh TK, Oh AY, Ryu JH, et al. Retrospective Analysis of the Association Between Intraoperative Magnesium Sulfate Infusion and Postoperative Acute Kidney Injury After Major Laparoscopic Abdominal Surgery. Scientific Reports. 2019;9(1):2833. doi:10.1038/s41598-019-39106-4.
    4. Sarenac O, Lazovic R, Vukcevic B, Lazovic JR, Palibrk IG. Impact of Perioperatively Administered Amino Acids, Lidocaine, and Magnesium on Inflammatory Response and Pain Associated With Abdominal Surgery: A Prospective Clinical Study. Medical Science Monitor. 2023;29:e939204. doi:10.12659/MSM.939204.
    5. Kim HY, Lee SY, Lee HS, et al. Beneficial Effects of Intravenous Magnesium Administration During Robotic Radical Prostatectomy: A Randomized Controlled Trial. Advances in Therapy. 2021;38(3):1701-1712. doi:10.1007/s12325-021-01643-8.
    6. Henyan NN, Gillespie EL, White CM, Kluger J, Coleman CI. Impact of Intravenous Magnesium on Post-Cardiothoracic Surgery Atrial Fibrillation and Length of Hospital Stay: A Meta-Analysis. The Annals of Thoracic Surgery. 2005;80(6):2402-6. doi:10.1016/j.athoracsur.2005.03.036.
    7. De Oliveira GS, Castro-Alves LJ, Khan JH, McCarthy RJ. Perioperative Systemic Magnesium to Minimize Postoperative Pain: A Meta-Analysis of Randomized Controlled Trials. Anesthesiology. 2013;119(1):178-90. doi:10.1097/ALN.0b013e318297630d.
    8. Evans MD, Barton K, Pritchard GA, Williams EJ, Karandikar SS. Plasma Magnesium Should Be Monitored Perioperatively in Patients Undergoing Colorectal Resection. Colorectal Disease. 2009;11(6):613-8. doi:10.1111/j.1463-1318.2008.01612.x.

    Vitamin B12 & Folate Evidence

    1. Tang X, Reidlinger DP, Crichton M, et al. Preoperative Micronutrient Repletion Strategies in Metabolic and Bariatric Surgery: A Systematic Review. Journal of the Academy of Nutrition and Dietetics. 2024. doi:10.1016/j.jand.2024.09.007.
    2. Myles PS, Chan MT, Forbes A, et al. Preoperative Folate and Homocysteine Status in Patients Undergoing Major Surgery. Clinical Nutrition. 2006;25(5):736–745. doi:10.1016/j.clnu.2006.04.003.
    3. Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update. Obesity. 2020;28(4):O1–O58. doi:10.1002/oby.22719.

    Vitamin D Evidence

    1. Mouli VH, Schudrowitz N, Carrera CX, et al. High-Dose Vitamin D Supplementation Can Correct Hypovitaminosis D Prior to Total Knee Arthroplasty. The Journal of Arthroplasty. 2022;37(2):274-278. doi:10.1016/j.arth.2021.10.016.
    2. Patel A, Caruana EJ, Hodson J, et al. Role of Vitamin D Supplementation in Modifying Outcomes After Surgery: A Systematic Review of Randomised Controlled Trials. BMJ Open. 2024;14(1):e073431. doi:10.1136/bmjopen-2023-073431.
    3. Abdehgah AG, Monshizadeh A, Tehrani MM, et al. Relationship Between Preoperative 25-Hydroxy Vitamin D and Surgical Site Infection. The Journal of Surgical Research. 2020;245:338-343. doi:10.1016/j.jss.2019.07.036.
    4. Turan A, Artis AS, Hanline C, et al. Preoperative Vitamin D Concentration and Cardiac, Renal, and Infectious Morbidity After Noncardiac Surgery. Anesthesiology. 2020;132(1):121-130. doi:10.1097/ALN.0000000000003000.
    5. Hung KC, Yu TS, Hung IY, et al. Impact of Vitamin D Deficiency on Postoperative Outcomes in Patients With Chronic Kidney Disease Undergoing Surgery: A Retrospective Study. Scientific Reports. 2025;15(1):9757. doi:10.1038/s41598-025-93807-7.
    6. Orloff LA, Wiseman SM, Bernet VJ, et al. American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults. Thyroid. 2018;28(7):830-841. doi:10.1089/thy.2017.0309.
    7. Turan A, Hesler BD, You J, et al. The Association of Serum Vitamin D Concentration With Serious Complications After Noncardiac Surgery. Anesthesia and Analgesia. 2014;119(3):603-612. doi:10.1213/ANE.0000000000000096.
    8. Mahamid A, Kazlow E, David AM, et al. The Association Between Preoperative Vitamin D Levels and Postoperative Complications in Patients Undergoing Colorectal Liver Metastasis Surgery. Journal of Clinical Medicine. 2023;13(1):115. doi:10.3390/jcm13010115.
    9. Laviano E, Sanchez Rubio M, González-Nicolás MT, et al. Association Between Preoperative Levels of 25-Hydroxyvitamin D and Hospital-Acquired Infections After Hepatobiliary Surgery: A Prospective Study in a Third-Level Hospital. PloS One. 2020;15(3):e0230336. doi:10.1371/journal.pone.0230336.
    10. Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update. Endocrine Practice. 2019;25(12):1346-1359. doi:10.4158/GL-2019-0406.

    Vitamin A Evidence

    1. Tang X, Reidlinger DP, Crichton M, et al. Preoperative Micronutrient Repletion Strategies in Metabolic and Bariatric Surgery: A Systematic Review. Journal of the Academy of Nutrition and Dietetics. 2024. doi:10.1016/j.jand.2024.09.007.
    2. Mechanick JI, Apovian C, Brethauer S, et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures - 2019 Update. Endocrine Practice. 2019;25(12):1346-1359. doi:10.4158/GL-2019-0406.
    3. Cummings KC, Keshock M, Ganesh R, et al. Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clinic Proceedings. 2021;96(5):1342-1355. doi:10.1016/j.mayocp.2020.08.016.