Purpose of Review <p>A subset of acute care surgery patients is emerging wherein surgical intervention can be delayed. These patients need a surgical intervention, but the question of operative timing with regard to nutritional status and nutrition provision remains: should surgery be further delayed for nutritional optimization with parenteral nutrition (PN) to reduce postoperative risks? This manuscript seeks to explore this question and best practices for managing these patients from a nutritional standpoint, particularly when these patients present with underlying malnutrition.</p> Recent Findings <p>Older data support a mandatory 7 to 14 days timeline of preoperative nutrition support, particularly among elective patients. Modern reports suggest further nuances in response to nutrition support based on the degree of inflammation present.</p> Summary <p>Acute care surgery patients presenting with a large degree of inflammation seem unlikely to benefit from delayed surgery in the name of nutrition optimization, however 4 days of preoperative parenteral nutrition may offer benefit.</p>