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Minor procedures such as cataract removal may not require much advance preparation. But a few smart steps in the month before a major elective surgery — such as a hip replacement or an open abdominal procedure — can reduce the risk of complications and may even speed recovery.
“Patients can impact their own surgical outcomes by trying to reduce the risk that they bring into the operating room,” says Michael Englesbe, a transplant surgeon at the University of Michigan.
That’s the idea behind “prehabilitation”: exercise, nutrition and counseling programs that aim to make you as healthy as possible before surgery. Some early research suggests it may help cut the length of a hospital stay — in one study, by 31 percent. Whether or not your hospital offers prehab, these strategies can help prepare you physically and mentally.
Check off your worry list
To reduce stress, have a plan in place for the day of surgery (know where you’ll park at the hospital, for instance). Identify a health-care proxy or surrogate decision-maker. “It’s good to have an advocate, someone to help you make decisions in the hospital if you’re not feeling well,” says Maria Torroella Carney, chief of geriatric and palliative medicine at Northwell Health in New Hyde Park, N.Y. That person also can help arrange support you may need after surgery.
Make sure your primary care doctor has a current list of all the medications you take. Some, such as anti-anxiety benzodiazepines, have been linked to greater risk of confusion or delirium after surgery. But don’t stop taking a drug without your doctor’s go-ahead.
Be smart with diet, exercise
Now isn’t the time to try to lose a lot of weight or revamp your diet drastically, Englesbe says. But do think about simple changes. For instance, you can cut back on sweets and consume more vegetables, fruits and healthy protein, he says.
And try to move more in the weeks before surgery, if you can. Use a pedometer or activity tracker app to monitor the number of steps you take every day. Try to increase that number by 10 to 20 percent each week in the weeks leading up to surgery, Englesbe says. If walking is out, do what you can to be less sedentary.
“That may mean sitting up more and not reclining as much,” Carney says.
Boost breathing power
Lung complications account for about 40 percent of all deaths during or after surgery in people 65 and older. After certain procedures, such as lung or open heart surgery, it can be more difficult to take normal breaths during recovery. Practicing deep, slow breathing for a few minutes each day in the weeks before surgery can help, Carney says. (If you’re unsure what to do, your doctor can provide a device called a spirometer that will train you to take such breaths.)
If you smoke, the American Society of Anesthesiologists recommends quitting before surgery. Smokers are more likely to have heart and lung complications after surgery, and may have more problems with general anesthesia during surgery and wound healing afterward. If you are unable to quit, try to cut back.
Avoid post-op delirium
Postoperative delirium is temporary confusion that can arise 24 to 72 hours after surgery, for a variety of reasons. It’s more common after major procedures and in older adults. Studies suggest it can occur in up to 60 percent of seniors after some surgeries, and it’s linked to a higher risk of needing nursing home care and long-term cognitive issues.
“As we get older, we have a lower threshold for becoming confused,” Carney says.
Taking steps before surgery to minimize the time you’ll need to spend in the hospital and the number of pain meds you’ll need afterward may help, Englesbe says. Both are factors in post-op delirium risk.
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