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.
A preoperative program at the Indiana University Health Center “dramatically reduced” hospital-acquired infections in surgical patients, according to research published in the October Annals of Surgery. A similar program developed at the University of Michigan “decreased hospital duration of stay, lowered costs of care, and was well accepted by patients,” read a study appearing in the June 2017 issue of Surgery.
“At the University of Michigan, we train every patient who has major inpatient surgery, at least abdominal and thoracic surgery. And the reason we do that is we feel strongly that it helps people to better weather the stressors of surgery,” says Michael Englesbe, a transplant surgeon who started the program. “The analogy that I usually use is that if you and I were going to run a [5K] race, you wouldn’t do it without preparing — you would prepare, you’d train. A two-hour operation is about as physiologically hard on a patient” as running that race.
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 (POSH) 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, Englesbe says. For instance, Michigan patients usually train between two and six weeks until the day before surgery. He explains that about 30 days before is a “bit of a sweet spot” because it allows for ample training time and high patient compliance. The Indiana program can be done in as few as six days, though the more time you have to prepare, “the better you will be,” says William A. Wooden, director of operative services at IU Health.
“I think everyone should train for surgery,” Englesbe says, though if you have problems with falling, he advises consulting your physician about physical activity.
Here are some other steps to consider and discuss with your surgeon — even if your facility doesn’t offer a formal program.
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.
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. “Oxygen is one of the most important things that you need to heal well,” Wooden says, noting that smoking impairs lung function and increases carbon monoxide in the blood, along with other harmful outcomes. “Giving yourself a smoking holiday, or, even better yet, [stopping] smoking for good, will dramatically improve your recovery from surgery and will also dramatically improve your health,” he says. Talk to your doctor if you need help to quit.
“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. “The number one thing that helps [patients] after surgery is getting up and out of bed,” McDonald says. So, exercising beforehand can give you a leg up (literally) after the procedure.
“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.
Another potential training benefit is the sense of control it can give a patient. Hugh Tenison, 68, of Richmond, participated in the POSH program before having back surgery in October and appreciated learning that there were steps he could take to improve his outcome. “All that information caused me to feel empowered,” he says, adding that he feels stronger every day.