The surgical cascade is a complex series of responses in the body after surgery that includes:

• Inflammatory response

• Immune system activation

• Metabolic changes including: • Gluconeogenesis (creating glucose from non-carbohydrate sources) • Decreased insulin secretion leading to higher blood glucose • Elevated cortisol causing increased protein breakdown • Potential muscle mass loss (up to 1% per day in older adults)

These responses can impact recovery if not properly supported through nutrition. Adequate protein intake is crucial to prevent excessive muscle breakdown, while proper carbohydrate timing can help reduce insulin resistance by up to 50%. The ERAS (Enhanced Recovery After Surgery) protocol provides evidence-based guidelines for optimizing these factors.