En español l Jean Hanson needed a new hip. After years of teaching P.E. and tearing up ski slopes all over the world, the Sedona, Arizona, resident was in so much pain that she relied on a walker. She finally decided to have surgery at the Mayo Clinic in Phoenix, but there was just one problem: Doctors there wouldn't do the operation unless she quit smoking.
It turns out that smokers, compared with nonsmokers, have nearly double the risk of suffering a heart attack, stroke or other severe complication during or immediately after surgery. Stopping for even a few weeks can make a dramatic difference. "It doesn't make sense for us to subject you to a huge operation if we know you are going to have the worst possible outcomes," says Tom Varghese, a thoracic surgeon and medical director of Strong for Surgery, a public health campaign aimed at optimizing patients' health presurgery.
Indeed, while your surgeon's skill is an important factor in determining how well you'll fare during and after surgery, your own actions matter more than you think. Here's what you need to do.
1. Get your blood sugar tested
Having high blood sugar during surgery quadruples the risk of dying during heart surgery and triples the risk of wound infection. Incredibly, a quarter of surgery patients without a prior diabetes diagnosis had elevated blood sugar on the day of their operation, according to a 2011 study in the journal Nutrition. If you're scheduled for surgery, make sure to ask your doctor to schedule a fasting blood glucose test.
2. Toss the cigs
Nicotine and other compounds in tobacco smoke constrict the small blood vessels, which increases the risk of heart attack during surgery and restricts the blood flow needed for wound healing. But if smokers quit for just a month before surgery, they have outcomes similar to those who never smoked, Varghese says. Sneaking just one cigarette before surgery, though, can raise blood pressure and reduce oxygen to vital organs.
Next page: Put on your walking shoes. »
3. Put on your walking shoes
After performing thousands of esophageal operations, University of Michigan thoracic surgeon Mark Orringer concluded that patients who weren't reasonably fit before surgery had poor outcomes. Today he won't operate on able-bodied patients who can't walk a mile. Robert Cima, medical director for surgical-outcomes research at the Mayo Clinic, agrees: "Having surgery is like running a marathon — it's like going into battle. You have to be prepared to recover from major trauma."
4. Ease up on the nightly martinis
Alcohol withdrawal is the only addiction withdrawal that can cause death during or after surgery, Cima says. Severe withdrawal can cause seizures, nervous system damage, an irregular heartbeat and respiratory failure. Moderate drinking is usually not a problem, but tell your doctor if you have more than one or two drinks a day.
5. Ditch the supplements
Ginkgo biloba, an herb many people take to boost memory, may cause dangerous bleeding during surgery. Ginseng, taken to improve the immune system, may affect blood sugar levels. Valerian, often taken for sleep disorders, can make anesthesia dangerous. So stop all herbal supplements two weeks before surgery, and tell your doctor what you're taking.
Next page: Address heavy snoring. »
6. Address heavy snoring
Patients with sleep apnea are much more likely than those without it to have breathing problems during surgery, says William Robb, chair of the American Academy of Orthopaedic Surgeons' Patient Safety Committee. And the problem is widespread. A study published in Sleep Medicine found that over 80 percent of surgery patients at high risk for sleep apnea were undiagnosed before surgery. If you snore frequently or often feel tired during the day, tell your doctor, who may send you for a sleep study. You may need to be fitted for a CPAP mask, and the surgical team may need to avoid giving you narcotics, which can cause breathing problems.
7. Mind your medications
Coumadin, Plavix and other blood thinners can cause bleeding problems during surgery. But quitting some drugs can be equally dangerous. For example, suddenly stopping beta-blockers triples the risk of a heart attack after surgery, according to a 2012 study led by David Flum, head of the University of Washington's Surgical Outcomes Research Center. Be sure to review your medicines with your doctor before surgery.
8. Down a nutritional drink
A full 15 percent of patients are dangerously malnourished when they come in for an operation, which significantly increases the risk of complications and death afterward, says Flum. Drinking a prescription supplement for four or five days before surgery can halve that risk.
After enrolling in a smoking-cessation program, Jean Hanson broke her 48-year habit. She had her first hip replaced a few months later, and the second the next year. She still misses smoking but is glad to have quit. "I feel much better," she says.
Elizabeth Agnvall is a writer and features editor for AARP Media.
Early in the week, early in the day and not in July, when new medical residents start. Also, crews are skeletal at night and on weekends, and more errors occur then.
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