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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.
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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.
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.