To recover quickly from surgery, take action before and after your operation


It’s wise to know what to expect in the hospital, to use painkillers wisely and to plan for after-discharge care. (Istockphoto)
December 31, 2012

If you’re scheduled for surgery, one of your main questions is likely to be “How long before I can get back to my regular life?”

As you might expect, the answer depends in part on what type of operation you’re having and how healthy you are going in. But much of it also depends on you. The following steps can help you improve your chances for a speedy recovery and reduce the risk of complications that can leave you sidelined longer than you intended.

Pick an experienced surgeon and hospital. Be wary of surgeons who are reluctant to discuss their level of experience or are vague about their complication and success rates. Experience is especially important for complex, high-risk procedures such as cancer surgery, coronary artery bypass and heart-valve replacement, and abdominal aortic aneurysm repair.

As for picking a hospital, Consumer Reports rates more than 4,000 hospitals nationwide on 17 measures, including infection and readmission rates, serious complications, mortality and patient experience. It also has a composite safety score for more than 1,100 hospitals. For details, go to www.consumerreports.
org/hospitalratings
.

Know what’s coming. Ask your surgeon what to expect in the immediate postoperative period. Will you be in the intensive care unit at first? What are the plans for pain relief? What tubes will you be hitched up to? Also, have a discussion about your expectations for recovery. Finally, discuss your medication. You should stop taking certain drugs and supplements before surgery because they can affect blood clotting. Diabetics who take insulin may need to adjust their doses.

Stay safe at the hospital. Two of the biggest risks of any hospitalization are medical errors and infections. Those are largely out of your control, but you can help mitigate the risk by arranging to have a friend or relative with you for most if not all of your stay to ask questions, monitor hand-washing and the administration of medication, make sure catheters and IV lines are kept clean and removed when they’re no longer needed (that doesn’t always happen), and speak up in general if something doesn’t seem right. If that’s not possible, consider hiring a private-duty nurse for the job.

Plan your discharge. Start asking about discharge plans soon after you’re admitted. Find out whether you will be going home or to a skilled nursing facility. If it’s the former, schedule home care if needed, and nail down plans for physical therapy or other rehabilitation. If you’re going home with equipment, such as drains or wound vacs (vacuum pumps to aid wound healing), make sure you or your caregiver knows how to operate them.

Don’t tough out pain. Doing so may set back your recovery, warns Alejandro Gonzalez Della Valle, an orthopedic surgeon at the Hospital for Special Surgery and an associate professor of orthopedic surgery at Weill Cornell Medical College in New York. After knee replacement, for example, “it is important that patients take the prescribed painkillers,” he says. “Good pain control allows them to rehabilitate faster and develop range of motion.” In contrast, those who are reluctant to take painkillers generally don’t do enough physical therapy, which can lead the knee to heal with thick scar tissue that limits range of motion, Gonzalez Della Valle says. Taking painkillers if needed can also make it easier to breathe and cough, reducing the risk of pneumonia.

Mind your bladder and bowels. While it is common for normal bowel activity to slow down after surgery, there may be something you can do to shorten that period. Chewing sugarless gum reduced the time to flatus (passing gas, an indicator of bowel function) by an average of 14 hours and the time to first bowel movement by 23 hours after intestinal surgery, according to an analysis in the April 2009 International Journal of Surgery.

As for your bladder, one risk is urinary retention, or the inability to urinate despite having a full bladder, a possible side effect of certain medication. Men with enlarged prostates are especially prone to this problem. The treatment for urinary retention is catheterization.

Tend to your incision. Common errors include touching the incision with unwashed hands and applying peroxide, lotion or antibiotic ointment to it. Don’t bathe or swim until your doctor says it’s okay, because water can soften the skin and cause the incision to pull apart. And don’t pick at the scab. If your incision is hot or red or seems to be pulling apart, call the surgeon right away.

Get moving, but carefully. You’ll probably be made to walk as soon after surgery as possible (it prevents blood clots and helps get your bowels moving again), but ask if there are restrictions you need to follow once you go home.

People with an incision on their upper body must be careful about lifting and about other arm motions that could stress it. Patients recovering from open-heart surgery, for example, have to learn to get out of chairs without using their hands. This avoids straining the breastbone, which was cut in half during surgery.

Copyright 2012. Consumers Union of United States Inc.

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