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Surgery savvy: Lower your risk

Surgery savvy: Lower your risk

If you’re facing surgery, you no doubt want to do all you can to prepare. But many of the things that patients are told to do, including some their doctor may recommend, aren’t necessary and can even cause harm.

For example, many doctors routinely order a battery of preoperative tests, including blood analyses, chest X-rays, and cardiac stress tests. But when they are done just to “clear” you for surgery, with little regard for the type of surgery, the kind of anaesthesia that will be used, or your overall health, they’re more likely to cause potentially harmful false alarms than keep you safe, current research shows. Yet many doctors continue to order them because of habit, concern about lawsuits, or the belief that other physicians require them.

Similarly, patients are still often told to avoid food and drink for 12 hours or more before surgery. But revised guidelines are more flexible; they take into account the fact that fasting too long can stress the body and slow recovery.

Fortunately, several professional groups are now focusing on what you really need to do before surgery. For example, as part of a program called Choosing Wisely, led by Consumer Reports and the ABIM Foundation, an organization founded by the American Board of Internal Medicine, nine medical societies recently clarified when specific preoperative tests are warranted and when they aren’t.

Other programs spotlight the steps patients should take before surgery to help their body and mind recover. “We’re trying to get people in peak shape before surgery, so we can give them the best possible outcome,” said Tom Varghese Jr., M.D., medical director of Strong for Surgery, a public-health campaign in Washington.

The following steps can help speed your recovery from surgery.


Don’t get overtested

Ordering preoperative tests when they aren’t necessary can lead to trouble. For example, some doctors order cardiac stress tests even for low-risk patients before minor surgery. But abnormal results can lead to angiography, a test that exposes people to radiation. And if that test detects a blockage in an artery, doctors might treat it with a stent, even though the artery wasn’t causing symptoms. The stent procedure must be followed by the prolonged use of a blood-thinning drug, which can make surgery riskier or delay it for up to a year.

“So a person who had no heart symptoms gets angiography, a stent, medication, and now can’t have surgery,” Douglas E. Wood, M.D., president of the Society of Thoracic Surgeons, said. “It’s a maelstrom of problems that could be avoided.”

The box below describes when preoperative tests are, and are not, necessary. If your doctor can’t give a clear reason, say you want to skip it.

Eat well

Doctors have long advised patients not to eat or drink anything after midnight before morning surgery because of the risk of regurgitating stomach contents into the lungs. But such fasting impairs the body’s ability to recover from complications. The American Society of Anesthesiologists says that healthy people can have clear liquids up to 2 hours before most surgeries and a light meal up to 6 hours beforehand. Nutrition is also key in the weeks before surgery. If you’ve lost weight because you’re anxious or ill, seek help from a dietitian.

Keep moving

Boosting your activity level, if only for a week or so before surgery, can help you get out of bed and walk around sooner afterward. That can prevent complications such as blood clots and pneumonia. In a 2013 review in the British Journal of Anaesthesia, people who were in an exercise program before heart surgery had shorter hospital stays. Walking a little bit more each day until you’re up to 30 minutes at least three times a week can make a difference.

Strengthen your lungs

People who are recovering from surgery are often told to take long, deep breaths using a device called an incentive spirometer. That helps prevent pneumonia and deliver more oxygen to the surgical site to speed the repair of wounds. But doing those exercises before you get to the hospital also leads to shorter hospital stays, according to a 2011 review in Clinical Re­habilitation. So ask for a spirometer before your operation and practice using it, especially if you smoke or have lung problems, you’re having chest or abdominal surgery, or you’re inactive or will have restricted mobility after surgery.

Relax

Psychological stress causes chemical changes in the body that impair the immune system. So it’s no surprise that anxiety has been linked to slower healing, more pain, and longer hospital stays. Patients who are worried may also focus more on pain and discomfort. But psychological interventions before surgery can reduce complications and speed recovery. If you have concerns about your operation, talk about them with your doctor. Other stress-busters include deep breathing, meditation, yoga, exercise, and listening to music.

Control diabetes

Blood sugar levels can spike after surgery, which can compromise your immune system and multiply the risk of pneumonia and wound or bloodstream infections. Talk with the doctor who treats your diabetes about things you should do before and after your surgery to control your blood sugar level.

Stop smoking

Smokers are more likely to need a ventilator to help them breathe after surgery. They also heal more slowly and are prone to infection. Quitting before surgery can reduce those complications. It’s best to kick the habit well before surgery, but it helps to stop even temporarily. So ask for smoking-cessation advice.  

Blood coagulation test

Detects or measures:

Bleeding and blood-clotting problems.

Consider the test if you:

• Have abnormal bleeding or bruising.

• Have liver disease.

• Use blood-thinning medication or take antibiotics long term.

• Are scheduled for brain, cancer, heart, or spinal surgery.

Blood glucose test

Detects or measures:

Diabetes.

Consider the test if you:

• Have diabetes or suspect that you do.

• Are obese.

• Use corticosteroid medication.

Breathing test

Detects or measures:

How well your lungs work.

Consider the test if you:

• Have lung disease, shortness of breath, or are unable to exercise.

• Are scheduled for lung, chest, or upper abdominal surgery.

Cardiac stress test

Detects or measures:

How the heart handles physical stress.

Consider the test if you:

• Have heart disease or are prone to abnormal heart rhythms.

• Are scheduled for major surgery and have risk factors such as diabetes or heart failure, plus you can’t walk a short distance or climb a flight of stairs without experiencing chest pain.

Read more about when you need a stress test before surgery.

Chest X-ray

Detects or measures:

Disease or infection of the lungs or heart.

Consider the test if you:

• Smoke or have symptoms of lung or heart disease.

• Are older than 70 with stable lung or heart disease and no recent chest X-ray.

• Are scheduled for major surgery, including chest, heart, lung, or upper abdominal operations.

Read more about when chest X-rays are needed before surgery.

Complete blood count

Detects or measures:

Blood disorders, bleeding problems, or infections.

Consider the test if you:

• Have symptoms of anemia or infection.

• Have a history of abnormal bleeding or bruising, or kidney or heart disease.

• Are scheduled for an operation that can cause severe bleeding, such as heart bypass or orthopedic surgery.

Read more about when blood tests are needed before surgery.

Electrocardiogram

Detects or measures:

Heart abnormalities.

Consider the test if you:

• Have symptoms of heart disease.

• Are scheduled for a moderate-risk operation such as orthopedic or prostate surgery, and you have cardiac risk factors such as heart disease or a history of stroke or mini-stroke, or if you’re scheduled for aortic or leg artery bypass surgery.

Read more about when an electrocardiogram is needed before surgery.

Kidney function test

Detects or measures:

How well the kidneys work.

Consider the test if you:

• Are 65 or older.

• Have a history of heart disease, high blood pressure, or diabetes.

• Use certain blood-pressure drugs such as diuretics (“water pills”) or NSAID pain relievers such as ibuprofen (Advil and generic) or naproxen (Aleve and generic).

• Are scheduled for major cardiac, chest, or abdominal surgery, or aortic or leg artery bypass surgery.

Urine sample

Detects or measures:

Diabetes, kidney disorders, and urinary-tract infection.

Consider the test if you:

• Have signs of a urinary-tract infection.

• Have diabetes.

• Are scheduled for urinary, gynecological, or genital surgery.

This article appeared in the October 2013 issue of Consumer Reports on Health.

Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2007-2013 Consumers Union of U.S.

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