Surgeons are tasked with making sure that the patients rolled into their operating rooms are good candidates for the surgery about to be performed.
By its nature, surgery is unpredictable, but certain lifestyle behaviors have been linked to improved outcomes. To determine who might best respond to surgery, some surgeons use assessment models that help predict risk. Many also share tips with patients on how to improve health ahead of time. Hospitals, organizations, naturopaths, and functional doctors often offer help preparing for surgery with many results-based programs on the rise.
But the key to any effort to lower adverse effects in surgery is patients who are invested in the benefits of being in tip-top shape for surgery.
Positive surgical outcomes are vital for the quality of life and functionality of patients after their operation. Although hospitals often look at it from a financial standpoint of cutting costs, preoperative programs often help patients implement advice that will change their lives for the better—perhaps even allowing them to delay or cancel surgeries.
Why Preparing for Surgery Matters
PLOS One recently published a review and meta-analysis of 76 trials and found behavioral interventions prior to surgery reduced the length of stay by 1.5 days. The most impressive results were from smoking cessation. Other interventions examined in the review included alcohol use, physical activity, and dietary intake.
“That improvements in smoking outcomes were sustained at 12-months post-surgery suggests that the surgical encounter holds promise as a teachable moment for longer-term behavioral change,” the meta-analysis reads.
In the review, there was no difference found in pre-surgical body mass index (BMI), but only four studies that targeted weight loss were included. For many surgeries, a BMI greater than 40—which is considered morbidly obese—is associated with serious complications before and after surgery compared to someone with average weight.
In fact, for hip and knee replacement surgeries, weight loss is often part of pre-surgical requirements. And it sometimes leads to patients canceling or delaying surgery.
According to Dr. Peter Hanson, an orthopedic surgeon affiliated with Sharp Grossmont Hospital, losing 20 percent of weight could reduce joint pain and stop the progression of arthritis. Joint replacement surgery is necessary only when deterioration has become severe.
How to Prepare
Weight loss can improve surgical outcomes in part because both diet and exercise—staples of weight loss efforts—have benefits that can improve health regardless of whether patients need to lose weight.- Boost your nutrition: Eat nutrient-dense, nonprocessed foods for at least two weeks prior to your surgery. Whole foods are those without a nutritional label. Avoid refined carbohydrates and added sugar. A diet that’s anti-inflammatory, low in saturated fats, and rich in vegetables and fruit is ideal. Also, eliminate alcohol and caffeine prior to your surgery, and hydrate your body.
- Kick bad habits: In addition to smoking and drinking alcohol, reconsider all mood-altering substances that affect sleep and cause anxiety. These could potentially interfere with anesthesia and cause poor results. According to the ACS, smokers have a 40 percent higher likelihood of complications.
- Review your medications: Prescription medications, as well as vitamins, herbs, and supplements, can potentially interfere with surgery. Certain medications increase bleeding risks, and herbal medications such as echinacea, garlic, ginkgo, ginseng, kava, saw palmetto, St. John’s wort, and valerian are known to increase risks. On the other hand, some medications and supplements are beneficial before surgery. This varies from patient to patient and is a vital part of pre-operative clearance. Although it’s the provider’s responsibility, you can protect yourself from oversight by being proactive.
- See your primary care physician: Having another expert review your medications, supplements, diet, and lifestyle can set you up for a more successful surgery. Some surgeons may require this, and it can also help prevent mistakes in the same fashion that getting a second opinion can.
- Exercise regularly: Movement matters because one of the first postoperative demands is to be able to walk on your own. All patients can train prior to surgery—even if they don’t regularly exercise—by increasing daily steps. This will improve cognition, gait, and balance. That translates to a reduction in surgery-related morbidity and mortality, decreases the length of hospital stay and rehabilitation, and reduces hospital readmissions, according to the ACS. Even chair-based exercises have been found to support strength and balance in older adults.
- Communicate directives: Talk in advance about the necessity of the surgery, financial burdens, pain and pain management, and other issues that affect decisions during and after surgery. Being educated and able to express feelings about the experience can help alleviate pre-surgical anxiety.
- Be evaluated for delirium: Recognizing and treating delirium before surgery helps avoid poor outcomes such as functional decline, longer hospitalization, and institutionalization, as well as greater costs and mortality. The ACS says delirium can be caused by alcohol abuse, poor cognitive or physical functioning, and age. Certain lab tests can help identify risks and identify if interventions would help.
- Do your own risk assessment: The National Surgical Quality Improvement Program that provides risk assessments for surgeons can also be accessed by laypeople online with a simple questionnaire.
- Support your emotional and mental health: Washington University recommends keeping a gratitude journal, which has proven to help reduce stress and improve health by lowering blood pressure, improving immune function, decreasing pain, and improving sleep.
Taking Charge of Your Own Health
If it all seems a bit overwhelming, or if a pre-surgical program isn’t available, a naturopath can help by offering holistic support throughout the surgical experience, Rosia Parrish told The Epoch Times.Naturopaths can guide patients to optimize their health through nutrition, supplements, botanical medicine, and lifestyle adjustments. They can also address anxiety and immune function and help patients lower inflammation.
“Collaborating with a naturopath can help you address both the surgical aspect and your overall well-being, promoting a comprehensive and balanced approach to your health journey,” Ms. Parrish said.
He said most of his patients are able to prepare more effectively for surgery because they’re already practicing the basics of a healthy lifestyle and good nutrition.
Those patients who are already healthy are the best candidates for surgery and make pre-surgical communication and preparation easier for themselves and the surgeon, according to Dr. Hanson.
“The discussion with someone who is overweight may be handled differently, as we ease into the topic of weight loss,” he said. “I spell it out that they must take the weight off. Although many of my patients are unable to exercise because of their medical condition and the additional weight, I tell them it is not always about exercise, but also diet control.”
Exercises for Those With Low Mobility
These chair exercises from Edward-Elmhurst Health will help you burn calories and build muscle even if you have trouble walking. Repeat each one until your body tires, keeping your core tight and your spine tall throughout.- Chair Stands: From a seated position, stand with weight in the heels, squeezing glutes. To lower to the chair, maintain a tight core, bend the knees, and shift the hips back.
- Heel Raises: Raise the heels off the floor while squeezing the calves. Pause for a few seconds and lower the heels back down.
- Leg Extension: Extend one leg while maintaining a flexed-foot position, pause while squeezing the quads, and then lower that leg back to the starting position. Switch sides.
- Leg Lifts: Bend one leg at a 90-degree angle, maintaining the angle while lifting the leg to almost hip height. Pause, then lower the leg back down to the starting position. Switch sides.
- Arm Circles: Extend the arms out directly from the shoulders, creating a “T” position with a slight bend in the elbows. Circle arms backward until tired. Rest. Circle the arms forward until tired.
- Shoulder Press: Place the arms at a 90-degree angle with the palms facing forward. Note: The elbows should be even with the shoulders. Move arms above your head, bring the arms together, separate them, and bring them back to a 90-degree angle. Add weight with light dumbbells or cans of soup.
- Bicep Curls: Keep your arms at your sides with the palms facing away from you, the shoulders down, and the elbows in. Refrain from moving your upper arms, and keep your wrists straight. Raise your forearms toward your chest, then lower your forearms back to the starting position. Add weight if desired.
- Chest Flys: Hold your arms at your sides with the palms facing away from your body. With the shoulders down and a slight bend in the elbows, move the arms in front of you and bring the palms closer together. Squeeze the armpit area, then lower the arms back to the starting position. Add weight if desired.
- Seated Twists: With the hands on the waist, twist your torso to the left (allow your head to turn to the left), to the center (allow your head to return to the center), and to the right (allow your head to turn to the right).