Getty Images
It doesn’t matter if you’re having your wisdom teeth taken out or a pacemaker put into your chest. Surgery, however helpful and potentially life-saving, is a trauma to the body.
“You can have a great surgery, but if the body’s response to that trauma is too high, that’s when complications happen,” explains Dr. Michael McGee, chair of Northwestern Memorial Hospital’s enhanced recovery program steering committee and a member of the Illinois Surgical Quality Improvement Collaborative.
That’s why U.S. hospitals are increasingly adopting guidelines from the ERAS (Enhanced Recovery After Surgery) Society, the American College of Surgeons and the American Society for Enhanced Recovery, which throw old rules like “don’t eat after midnight the night before your surgery,” “stay in bed and get your rest” and “only eat ice chips” out the recovery-room window.
“We are flipping the entire paradigm on its head,” McGee says. “We found that with the old guidelines, physicians were overtreating a lot of patients and causing rather than alleviating problems with recovery. Not too long ago, following surgery we took a very dramatic dietary progression with patients, from ice chips to one sip of water, all the while giving them lots of IV fluids. Now we are going to feed you right after surgery, and get you walking the night following surgery. The sooner you can get back to everyday life and stop unnatural interventions, the better your body heals.”
Still, the road to recovery begins long before you go under the knife. Here are four things to do prior to surgery that will help you come out of it strong.
1. Gain a complete understanding of the surgery and recovery process. “The more educated patients are about their surgery, the better they do,” McGee says. “We like to spell out for patients exactly what we are going to do as a team before, during and after surgery. It relieves anxiety and allows them to go in confidently.” Remember, your mental outlook has a huge impact on your physiological stress levels and your body’s ability to recover. For instance, a 2013 study published in the American Journal of Cardiology found that, in older patients undergoing cardiac surgery, high levels of preoperative anxiety are a strong predictor of postoperative mortality and complications, even after controlling for other factors.
Ask questions, and keep asking until you understand the whole picture, including what steps your health care team will take to help promote the best recovery possible. Ask if the surgical team uses an enhanced-recovery protocol. “If you have the opportunity to shop around, look for someone who does,” he says.
Don’t just assume doing the research isn’t worth the trouble. While research suggests that the vast majority of surgeries in the U.S. are conducted in ways that directly contradict enhanced recovery protocols, a 2017 JAMA Surgery study of more than 15,000 patients found that implementing the ERAS protocol is associated with shorter hospital stays and a one-third reduction in complication rates as well as a decreased risk of mortality.
2. Get your entire health checked out. “No one should have surgery in the U.S. without being screened for risk factors including malnutrition, anemia, diabetes and pain – and if present, having these issues addressed,” says Dr. Paul Wischmeyer, an anesthesiologist and critical care specialist at Duke University Hospital, which in 2016 launched its Perioperative Enhancement Team, or POET, for that purpose. “POET is a series of pre-operative clinics and pathways to screen for key surgery risks,” he explains. “If any are present in a patient, we have pathways to address and correct or optimize these issues before a patient ever has surgery.”
For instance, while 29 million Americans currently have diabetes, 1 in 4 is unaware of having the condition – and poor blood-sugar management often predicts complications and poor surgical outcomes. Consider surgery the perfect time for a comprehensive health check, and talk to your surgical team about what pre-operative screening measures are available to patients.
3. Dial in your exercise and nutrition. Taking weeks or months before surgery to optimize your physical fitness and nutrition isn’t an option for everyone. But it’s a must for everyone who has the ability to do so. “No one should have elective surgery without being the best they can be,” Wischmeyer says.
For example, at the University of Michigan, implementing a preoperative program that included nutrition and exercise was shown to get patients out of the hospital two days faster and cut patient costs by 28 percent. “You need to prepare your body to have the strength and energy needed to endure the operating table and have a successful recovery,” explains Christina Sherry, a research scientist and registered dietitian at Abbott.
While the best nutrition plan for you depends on your current health and surgical needs, Abbott research shows that consuming immunonutrition drinks fortified with the amino acid arginine and omega-3 fatty acids prior to surgery can reduce the risk of post-surgical infection and shorten hospital stays. Meanwhile, a Cochrane review of 27 previous trials concluded that carbohydrate-loading prior to surgery consistently improves recovery.
“Consuming a specialized carbohydrate-rich drink up to two hours before undergoing anesthesia allows for better control of the insulin response during and after surgery, as the trauma of surgery can result in short-term insulin resistance,” Sherry says.
Wischmeyer recommends talking to your surgeon about both immunotherapy and pre-operative carbohydrate-rich beverages, as well as potentially increasing your protein consumption – both through whole foods and supplements.
“We have data showing the amount of muscle you start with is a major predictor if you will have real complications, or even survive, a major surgery,” he says.
Increasing your participation in muscle-strengthening exercises, especially in tandem with adequate protein intake, can significantly improve muscle health going into surgery. Talk to your surgeon about what exercise is recommended or contraindicated as you gear up for surgery, says McGee, noting that many hospitals offer prehabilitation programs designed to guide you through the exact exercise program your body and surgery need.
4. Kick your addictions. Now’s the time to finally quit smoking. (And, yes, that includes e-cigarettes.) “We see immediate benefits in lung function and wound healing in people who quit just one week before surgery,” McGee says. Smoking increases the risk of blood clots, reduces the ability of blood to carry oxygen to the tissues that need it and increases stress on the heart, while even smokeless nicotine damages the lining of the arteries. Plus, you can’t smoke in the hospital anyway, so you might as well start cutting back now.
In addition, a 2013 meta-analysis found that patients who drink heavily leading up to surgery (defined as more than two drinks per day), are more than twice as likely to die in the month following surgery compared to non-drinkers. They are also 80 percent more likely to suffer from breathing difficulties, 73 percent more likely to develop infections and 29 percent more likely to require intensive-care unit admittance. According to researchers, heavy alcohol use weakens the body’s immune function and increases the physiological stress response. Fortunately, research also shows that not drinking during the four to eight weeks prior to surgery can significantly improve surgical outcomes in otherwise heavy drinkers.
Be honest with your surgeon about your current or past use of drugs and alcohol, and don’t be afraid to ask for help in making a change. Consider surgery an opportunity to take control of every aspect of your health.
Written for USNews.com