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Are You Ready for Surgery?

The Physical Game

Peer Reviewed

The morning you have been dreading has come. It is the crack of dawn and your family is about to help you to the car and drive you to the hospital for your long awaited operation. Have you done everything you could to prepare for surgery?

It seems like a strange question, doesn’t it? What do you mean: have I done everything I could to prepare for surgery? I don’t need to prepare for surgery—my surgeon needs to prepare for surgery. I just need to show up.

On the contrary, you need to prepare for your surgery just as much as your surgeon does. You are about to enter one of the most important athletic contests of your life. What athletic contest is that, you ask? It’s your operation. It is a competition between pain and comfort, disease and wellness, happiness and sadness.

Think about it. There are many parallels between surgery and athletic contests. Your surgeon will enter a locker room, put on a uniform, scout out the opponent (your disease as demonstrated by your CT and MRI scans), enter a hallowed ground to perform difficult technical tasks, and, with the help of a skilled team of professionals, do battle against your nemesis (the disease that has brought you to the operating room).

It follows from those similarities that you are involved in a very important athletic contest—one in which you are the central figure. You must prepare for this moment of truth. You must stack the deck of cards in your favor. The most successful technical operation means nothing without the proper patient preparation and attitude.

How Can You Prepare for Surgery?

First, you must physically prepare your body for the stress of undergoing surgery. Not all people have this golden opportunity, as some operations are urgent or even emergent. If you do have time to prepare physically for your surgery don’t squander this opportunity.

Eat Right

Good nutrition is paramount in keeping your immune system healthy. By eating a balanced diet with vitamin supplements in the weeks before your surgery, you will have a higher chance of healthy wound healing and decreased chances of infection. Dietary supplements are a controversial medical issue. Suffice it to say that the best form of nutrition is a healthy, balanced diet from the four food groups. There are some encouraging results from studies looking at various dietary supplements and their effects on health and nutrition. They will be reviewed in a future spinal column.

If you are overweight, it is a good idea to slim down before your surgery. This should be done gradually with safe and proven dietary modifications. If you are considering a significant weight loss program (greater than 25 pound weight loss), this should be under the supervision of a licensed professional nutritionist or physician.

Particularly with spine surgery, unnecessary weight is baggage that the spine must accommodate. If one likens the spine to a flagpole stabilized by guide wires of the back musculature in back and abdominal muscles in front, it follows that any additional baggage in front will put unnecessary strain on the spine. This additional strain can inhibit the healing process, and increase post-operative pain. To convince my back pain patients that are overweight of this point, I ask them if carrying a gallon of milk (eight pounds in weight) or a grocery package (typically a few pounds more) makes their back pain worse. Invariably they say yes. I try to point out that that is exactly what they are carrying internally if they are significantly overweight.

Although one should not have drastic weight changes shortly before an operation, a carefully planned weight reduction program can optimize surgical results. Moreover, by making a lifestyle change prior to surgery, a patient is more likely to continue better eating habits in the post-operative period. These habits may lead to a healthier lifestyle and better long-term health.

Get in Shape

sports tennis serve man color photo
This may not make sense to you, but it makes perfect sense to your body. The weaker your muscles and cardiovascular endurance are entering surgery, the harder it will be to get on the comeback trail. Ever wonder how professional athletes can undergo major operations and return to the playing field one or two months later? It is because they are in such excellent condition that their recovery time can be quite short. Maybe their knee is not functioning well, but they compensate with other exercises like swimming and upper body weight lifting. Their muscular tone and strength going into surgery is on such a high level that the down time of surgery is only a minor setback. I have seen many athletes in all sports working out their uninjured muscle groups even the day before their surgery.

Age is not barrier. You can improve your health at any point in your life by engaging in a sensible exercise regimen. And you can improve your chances for surgical success no matter how old you are if you enter the OR in your peak physical condition. This may require physician or professional trainer supervision if you are just starting out. There is strong evidence to suggest that light weight, high repetition exercises with a focus on cardiovascular endurance will improve pulmonary function in the elderly. This could translate into lesser dependence on oxygen in the hospital and quicker recovery time. Walking is another excellent exercise to prepare for surgery if your pain is not limiting your activity.

Also remember that exercise boosts your immune system, and it can counteract depression, a common emotion prior to surgery. I try to encourage my patients to stay in shape any way they can prior to surgery.

Stop smoking

tobacco use smoking man with cigarette in mouth
This sole lifestyle change is one of the most important actions you can perform in your life. If you have planned to quit smoking in the past, consider your surgery a golden opportunity to embark on that mission. Smoking significantly increases your chances for an unsuccessful operation and complications. The ill effects of smoking on lung function during and after anesthesia are multiple. A smoker has a much higher chance of developing pneumonia after surgery than a non-smoker. Also, smoking is well known to advance the arthritic processes on the spine. It may have helped bring you to the OR in the first place! Smoking also significantly increases the chances of failed spinal fusion. In fact, some spine surgeons refuse to perform fusions on smokers.

Even if you plan to return to smoking after your surgery, there is good evidence that temporary abstinence from smoking during the pre- and post-surgical periods improves outcomes and decreases complications. Ideally, you should stop at least one month before your surgery. This will allow some of your pulmonary function to improve, decrease the amount of secretions your lungs produce, and clear your body of all remaining nicotine and carbon monoxide (yes, smokers actually inhale small amounts of the deadly gas carbon monoxide when they inhale cigarette smoke).

Physical Preparation—Conclusions

Although it may not be possible to stop smoking, lose weight, or get in shape if in severe pain, it is important to understand that you do have some internal controls when it comes to elective surgery. By following the above suggestions, you will optimize your chances for recovery and know that you have done all you can to improve your health.

Updated on: 02/01/10
Richard G. Fessler, MD, PhD
Dr. McLaughlin's comments are right on target, and point out a very important fact which many people (patients and physicians) often forget. Surgery is a contract between a physician and his patient (and family). The physician promises to utilize his skills and training to the extent of his ability to safely perform a surgical procedure on his patient; one which he/she believes will help that patient. The patient, however, must also promise to do his/her utmost best to maximize the potential results of that surgical procedure. This includes following you doctors instructions as closely as possible, preparing mentally, preparing physically, eating well, sleeping well, and stopping activities which might increase risk or decrease potential success (e.g. smoking). By adhering to this contract closely, the chances are excellent that the surgical procedure will be performed safely, the results will be as expected, and both the patient and the physician will be happy with the result.
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