Interviewer: How can you prepare for surgery so you have a better recovery? That's next on The Scope.
Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.
Interviewer: For a long time the responsibility of the outcome of a surgery was kind of placed on the surgeon's shoulders. But more and more, we are learning that the things you do or that you don't do as a patient can significantly impact the outcome of surgical procedures. Dr. Thomas Varghese is head of the section of general thoracic surgery at the University of Utah Health. What do you tell your patients that they can do to prepare for upcoming elective surgeries?
Dr. Varghese: The reality is that patients have much more power in determining the outcome of the surgery. It's not just the surgical technique.
Interviewer: The skill of the surgeon or the facility you go to, which are important . . .
Dr. Varghese: And don't get me wrong. Absolutely, there is a lot of data out there saying that going to an experienced surgeon, going to an experienced center really makes a difference. But there's also specific aspects where the patient health really makes a difference. So let me give you some examples.
One thing is nutritional status. We know there's over 40 years of literature in the surgical field where if a patient is malnourished coming into the surgical intervention, they are starving, they've had unexpected weight loss, their protein levels are abnormally low, those will lead to higher morbidity and mortality and complications, you know such as after G.I. surgery where there is a hookup or osmosis in the leak, those complications go up significantly after surgery.
We know in the area of blood sugar control that the best way of framing it is not just for diabetics but in patients who respond poorly to the stress of surgery and have abnormal blood sugar levels. If you have higher blood sugar levels around the time of surgery before, during and after, those patients have increased levels or increased incidents of infections after surgery as well.
Smoking is another area. We know that there's so much evidence that it's not just respiratory complications that smokers are at risk for. It's also increased risk of strokes, increased risk of heart attacks, increased risk of death after surgery. And so getting smokers to stop smoking before their elective surgery makes a huge difference.
And probably the final area where there's a lot of evidence that has emerged is also a direct correlation with medication. There are certain medications and supplements which increase the risk of bleeding after surgery. And getting those patients to understand what those medications are, what those supplements are and getting them to stop before surgery really makes a difference.
Interviewer: And how far in advance would someone have to start kind of optimizing these before their surgery for it to really make a difference?
Dr. Varghese: Historically, people mistakenly thought that these type of interventions took months before surgery. But the reality is that a lot of these things may take even as little as a couple of weeks, two to three weeks. Probably the longest time period is for smoking cessation. If you look at the recent literature, for example, in 2011 there was a meta-analysis in the Archives of Internal Medicine, where they really said that three weeks of smoking cessation.
And really, smoking cessation is an all or none phenomenon. You really have to work with patients and get them completely off smoking. Three weeks prior to the intervention was enough time period to make sure that they had enough better outcomes.
Nutritional interventions, probably a couple of weeks before surgery. Medication optimization especially with the supplements that lead to increased bleeding, again a couple of weeks before surgery is plenty. And then blood sugar control, the data is a little bit varied in terms of the time period, but again one to two weeks before the surgery. So we are not really talking about long period of time in terms of getting optimized prior to your surgery.
Interviewer: We're talking about elective surgeries where you actually do have the ability to control some of those things beforehand. And there've been times I've heard stories of somebody who has been in an accident and they go through surgery and then they recover and somebody might say, "It was because you were in such great shape that you recovered as well." So all of these things would contribute to that. What about physical exercise as well?
Dr. Varghese: Great question. Physical exercise has been a little bit messy in terms of the literature, and I think that there are a couple of different factors for that. Some of the clinical trials that have been conducted historically have been unrealistic. You know, they've been asking patients to report back every single day and use very, very expensive equipment with a physical therapist monitoring every single step of the way. This is not really pragmatic in the real world.
The general recommendations for the population at large is that we should be doing five days a week of moderate-level exercise, you know, 30 minutes of moderate-level exercise to improve your health. At the time of surgery what we do as a general recommendation, something as simple as starting a daily walking program where we say you set aside some time, morning noon, or night, you go for a walk, and the goal being you add on a couple of miles per day of walking in addition to what your normal level baseline level of activity is. Something as simple as that has been shown in the literature to make a huge difference in terms of your outcomes.
Interviewer: So I think the takeaway is to know if you are going in for an optional surgery that there are things you can do. Your nutrition, your smoking, your blood sugar and your medications that can really impact the outcomes. So be honest with yourself, be honest with your physician. If somebody is in a place where this isn't being . . . is this pretty commonly practiced with physicians?
Dr. Varghese: I think the honest answer is that there is increasing recognition. Unfortunately, there is still widespread variation in terms of the amount that people are doing. What we are hoping to do is not only getting more physicians involved in this movement, but the people who are the most powerful, who can really truly make a difference are the patients.
We are hardwired in all our aspects of our lives to be prepared before we embark on our journey. Why wouldn't you do the same thing for big time surgery as well? You know that if you are about to have elective surgery, you know when the surgery date is, why not empower yourself? Why not get engaged? Why not try to get into the best possible shape going into that elective surgery?
You will truly make a huge difference in your outcomes in terms of your recovery, the safe passageway through the surgery, as well as your ability to resume your normal activities. And I think that patients have the ultimate power and the more engaged your patient is coming into their elective surgery, the better that they'll do.
Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.
updated: May 29, 2019
originally published: August 2, 2017
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