Your surgery is considered a success by most surgeons and hospitals if you wake up and leave the hospital without major complications.
That isn’t to say that your surgeon doesn’t care how you feel in a week or 30 days or 12 months. Some might follow your recovery, while others may never check in again. Shortsightedness is the byproduct of an overburdened health care system and cumbersome protocols.
Patients might be frustrated that their surgery didn’t fix the symptoms that brought them to the operating table, or that they have new symptoms. Additionally, some are confused by the shift from one doctor to another, a lack of continuity that can undermine their recovery.
Functional Recovery as a Goal
Since nearly 80 percent of surgeries are elective, there’s time for health care providers to educate patients and set goals with them and their caregivers about measures that can improve recovery.Such goals should focus on the quality of postoperative life, given that mortality is rare and therefore a superficial patient goal, the Anaesthia article notes.
“Having survived surgery, most patients, especially older patients, would want to return to the same, if not better, level of independence and function (i.e., work, care for themselves, and be socially engaged),” according to authors K.S. Ladha and D.N. Wijeysundera.
For instance, if the surgery is to alleviate major joint arthritis, that should be a key measurement—in addition to the patient not experiencing any adverse events related to surgery.
This is where it gets a bit sticky. For one, the authors argue that the system isn’t designed to consider downstream complications, which are difficult to separate from other potential causal factors. A number of factors outside of a surgeon’s control can shape patients’ rehabilitation. Also, surgery itself is a complication because tissue injury can impair patients’ postoperative function.
“Based on this perspective, it’s important to appreciate that surgery can have deleterious effects even in the absence of an obvious complication,” Mr. Ladha and Mr. Wijeysundera wrote.
Anesthesiologist Dr. Anthony Kaveh describes surgery as a controlled trauma.
“Surgery is destroying your body’s tissues,” Dr. Kaveh told The Epoch Times. “Your body needs to regenerate them and that takes energy. It takes nutrition.”
Choosing Function Over Intervention
Hospitals commonly give the most weight to metrics such as length of hospital stay and readmissions, which offer limited perspective.Even in the group with mild disabilities, only about 10 percent recovered rapidly from surgery, whereas those who were moderately or severely disabled gained no rapid benefits in function after surgery. Outcomes were better in those who had elective surgery versus emergency procedures, and recovery offered gradual but often partial gains for most.
Hope Found in Enhanced Recovery Pathways
It’s possible that up to 25 percent of all surgery patients who suffer postoperative complications might also experience some level of surgery regret, if not disappointment. Patients in this group could have serious new health conditions that might even lead to death. These cases all inevitably increase health care costs, too.These best practices emphasize pain control, early mobility, adequate nutrition and hydration, and engaged patient participation. Research backs each point for improving patient outcomes.
The Bureaucracy of Surgical Recovery
A study of 151 hospitals using ERPs for colorectal surgery found that 85 percent had difficulty complying with it. Some of the reasons include entrenched dogmas, lack of staff, lack of time, patient resistance, and the inability to streamline it.Common Mistakes Made in Recovery
Even if their hospital doesn’t use ERPs, patients and caregivers may find it useful to understand what such programs offer.1. Unprepared Patients Have Lower Satisfaction and Worse Outcomes
Patient education is vital in surgical recovery, and surgeons should begin preparing patients for their own recovery before admission and beyond discharge.“Population health literacy levels are generally low, and the materials should use plain language and pictures,” according to SAGES.
2. Extended Fasting Can Increase Complications
Dogma that patients should avoid eating or drinking for up to 24 hours before surgery persists in spite of evidence that contradicts it. Patients are often told not to eat or drink after midnight to reduce the risk of aspiration when anesthesia is induced.This extended period without nutrition or hydration can be especially stressful for those whose cases are later in the day. SAGES ERP protocol said it’s best to cease oral fluids two hours before surgery, which can help decrease anxiety, hunger, and thirst in waiting patients.
Unless patients have dysphagia, obstruction, or gastroparesis, the American Society of Anesthesiologists (ASA) recommends a six-hour fast for solids and a two-hour fast for clear fluids.
3. Staying in Bed Leads to Longer Hospital Stays
Patients leave the hospital more quickly when they can spend time out of bed and engage in physical activity after surgery. SAGE said evidence on the exact amount of movement is lacking. Its protocol insists that patients eat all meals seated out of bed and walk the length of the hall at least three times.It’s very common for someone who’s had surgery to want to sit and rest, but they need to focus on a return to normal function, according to Dr. Matt Hatch, anesthesiologist and vice chair of the ASA committee on communication.
“Especially in the orthopedic world, the best thing they can do for their new joint is to get up and move,” he told The Epoch Times. “As we age and are more and more unhealthy, and organ systems may not be fully functioning like they did in our youth, trying to get muscles moving, using your mind, reading, getting up walking, that is the best thing.”
4. Poor Acute Pain Management Can Lead to Chronic Pain
Self-reported pain scales—the norm for measuring and mitigating suffering—have been criticized for being a contributing factor to the opioid epidemic and the increase in over-sedation.A key part of ERPs is encouraging doctors to avoid opioids while seeking optimal pain management. The emphasis is on keeping pain scores at or below a four on a scale of 10. Most postoperative medication is a nonsteroidal anti-inflammatory drug such as acetaminophen. Opioids are to be given only if the pain scores rise above four.
Other Things to Consider
Patients can also avoid some complications by planning ahead in practical ways that aren’t part of hospital ERP protocols. Some insurance companies offer care managers to help coordinate additional assistance.For instance, your insurance may cover durable medical equipment—things such as wheelchairs, walkers, and commodes. If a wheelchair ramp, grab bars, or other permanent modifications are suggested, some insurance plans may offer reimbursement through flexible spending or health savings accounts.
You might also plan in advance for a caregiver who can help you with practical concerns such as groceries and meals, prescription pickup, bill paying, and housework.
Plans for taking care of practical needs can help alleviate anxiety and depression, which aren’t uncommon complications of surgery.
Symptoms vary, but anytime they interfere with day-to-day activities or relationships, they can be cause for concern. Pain, complications, limited mobility, financial strain, and isolation are all contributing factors.
“Depression can get worse after surgery for any number of reasons. You might not be working. You might be under financial duress. You might not be able to cook for yourself. You might gain weight. All these things can happen that can hurt our psychological state,” he said.
Integrative Tools
Finally, you might also consider supporting recovery with additional tools such as nutraceuticals and various immune boosting and detoxification practices.Dr. Hatch said it’s best to also let your doctors know what you’re doing because some natural remedies interact with medications. He said that doctors may also introduce them to proven recovery tools they’d not heard of before.
“I’m just a big proponent of detoxing periodically to get the body back to square one. That, to me, is optimal health,” he said.