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Sunday, March 3, 2024
March 3, 2024

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Planning elective surgery? Try training for it

Doctors say it helps patients recover, avoid complications


These days Americans train to get in shape for marathons, weddings and backpacking trips. So why not for surgery? Tens of millions of surgeries are scheduled each year in the United States, and each can result in complications such as shock, infection or pulmonary issues: A 2012 study citing hospital data from the American College of Surgeons on 551,510 general surgery patients found a complication rate of almost 17 percent.

Providers at several hospitals believe better preparation could help patients awaiting elective surgeries — those planned in advance, such as hip replacements or cosmetic procedures, rather than done in an emergency — avoid those problems. They designed programs to help ensure that patients enter surgery in the best condition possible.

Like fitness-training programs, preparing for surgery includes physical and mental components. It is particularly important for older patients, patients who have “any component of frailty” (such as functional problems or difficulty with mobility), patients having major surgeries with extended hospital stays and patients with malnutrition, Englesbe says.

Because older adults, especially those with chronic conditions, are at increased risk for surgical complications, Duke University Hospital in North Carolina offers the Perioperative Optimization of Senior Health program. Participants on average had shorter hospital stays, lower readmission rates and a greater likelihood of being discharged home, researchers wrote in the May issue of JAMA Surgery.

One key to training is establishing start and stop dates, said Michael Englesbe, a transplant surgeon who started a preoperative program at the University of Michigan. For instance, Michigan patients usually train between two and six weeks until the day before surgery.

Here are some other steps to consider and discuss with your surgeon even if your facility doesn’t offer a formal program.

• Prepare your mind:

Before agreeing to surgery, understand the procedure, benefits and risks, and what recovery will be like, among other key points. “Getting people prepared for surgical pain and the expectations around it can really help them have better pain care after the operation,” Englesbe says. And because stress and depression can be associated with surgical complications, patients can adopt relaxation techniques, such as prayer, meditation or guided imagery, that they can use before and after surgery, according to Shelley R. McDonald, part of the research team and an assistant professor of internal medicine in the geriatrics division at Duke University Medical Center.

• Breathe and stop smoking:

Breathing exercises before surgery can help strengthen your lungs and protect against respiratory complications. Ask your doctor which exercises may work best for you. And if you smoke or use tobacco, quitting before surgery (even for just a few weeks) can help your recovery.

• Start moving:

“People really get shocked sometimes at how tired they are after surgery,” McDonald says. To help build your endurance, you can start a walking program at least two weeks before surgery, even if it’s for 20 minutes a day. Strengthening your core, arms and legs also is helpful.

• Stay hydrated and eat well:

“If people are malnourished or dehydrated, they have a greater chance of getting delirium,” McDonald says, referring to the post-surgical complication (more common among older adults) that can initiate issues such as longer hospital stays. Make sure you’re drinking enough water and getting good nutrition, especially in the seven to 10 days before surgery, she says. Talk to your surgeon if you have questions, and ask what time before your surgery you should plan to stop eating and drinking.