No personal experience here (not having been underweight in about 30 years) but a few observations compiled from a few sources:
Making it through major surgery and recovering afterwards is a strong challenge to the body in many ways. In most systems, the body has substantial reserves - extra function not needed on a daily basis. You can feel well and have no difficulty with usual activities, and still find problems tolerating and recovering from major surgery. This is because the body counts on these reserves to handle the extra stress involved in surgery.
Before any elective surgery, an older person should consider the stress involved in recovery and do all he or she can to build body reserves in nutrition, strength, and fitness. The most important phase of rehabilitation is the work done before the insult, that will determine the body's reserves and the ability to handle the stresses to come. "Prehab" beats rehab.
Even though you are lying motionless, surgery uses a lot of energy. You can prepare your body physically as well as psychologically, even if you are feeling unwell. You can have protein malnutrition even if you are not terribly underweight, particularly in the later years of life. In one study with 50,000 patients, 25 percent of men (average age 61) who were awaiting surgery had low protein levels. A low protein level increases chances of death and complications after surgery. In the time before your surgery eat high quality protein foods , like meat, fish, chicken dairy products, eggs. If you are on a low fat or vegetarian diet, beans, with whole grains, nuts and soy products are good protein sources.
Being underweight also slows healing, so you can see from the above that if he hasn't already got one, he could use the services of a nutritionist to advise on an optimal, pre-surgical diet.
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