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

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

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

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

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

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