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En español | Many of us believe that postsurgical recovery begins the moment we get wheeled out of the operating room. But in fact, says Clifford Ko, M.D., director of the Division of Research and Optimal Patient Care at the American College of Surgeons, “what you do in the weeks leading up to your procedure can play a big part in helping you bounce back more quickly.”
To that end, many health care providers have started incorporating prehabilitation therapies into their programs. Research suggests that prehab — getting into shape and optimizing your physical condition before your surgery — may help older adults prevent complications, trim the time they have to stay in the hospital and determine whether they recuperate in a rehabilitation facility or at home.
According to a 2019 study conducted by the University of Washington School of Medicine, 64 percent of the patients who walked two miles a day and consumed specific beverages before undergoing surgery to remove cancerous tumors from their pancreas, which can leave patients in the intensive care unit (ICU) for weeks, were discharged within five days. Here's how to lay the groundwork for a smooth recovery.
Schedule regular walks
“After almost all operations, we want our patients to get out of bed as soon as possible,” Ko says. Moving about improves circulation to prevent blood clots, lowers the risk of atrophy and can boost your mood. If it's OK with your physician, before stepping foot in the hospital, build up your endurance with 20 to 30 minutes of walking at a moderate speed, five days a week. Monitor your steps with a pedometer, and try to increase your distance a little each day.
"One of the things that determine when you'll get to leave the hospital, where you'll go after you're released and how long you may have to recover in a facility is your ability to go to the bathroom safely on your own,” says Lindsey Yourman, an internist and geriatrician in La Jolla, California, who is affiliated with the Jacobs Medical Center at University of California San Diego Health. “Whether it's heart surgery or orthopedic surgery, that can become something that is compromised from bedrest.”
Before your procedure, strengthen your quad muscles (needed for getting in and out of bed) by doing sit-to-stand exercises; try 10 reps a day. And ask your insurance company if it will pay for a physical therapy session before you enter the hospital so you can learn other exercises for the muscles that are relevant to your surgery, Yourman suggests. “If you've had other indications for therapy, say, you've had some falls or trouble with balance, it may be covered.” For those who are frail, there are in-bed exercises, such as rolling over, going from a supine position to a sitting position, flexing your ankles back and forth, and boosting your grip strength (important if you have to use an assistive device). Hold a tennis ball in each hand, squeeze as hard as you can for five seconds, then relax slowly. Repeat 10 times.
Pulmonary conditions, including pneumonia, are among the most dangerous postoperative complications. And they're pretty common. “One of the things that affect lung function is how deeply you're able to breathe after surgery,” says Mark Neuman, M.D., associate professor of anesthesiology and critical care at the University of Pennsylvania Perelman School of Medicine.
Bolster your lung power by getting a spirometer, which is a tube you blow into using strong, deep breaths to expand your lungs. (You can get one at a local pharmacy, big-box store or online for about $10.) Use it 10 times, once a day. Simple deep-breathing exercises can also strengthen your diaphragm and core muscles. Yourman suggests box breathing: Inhale deeply through your nose for four seconds; hold that breath in for four seconds; then take a deep breath out of your mouth for four seconds. Wait four seconds before taking another breath. A bonus, according to Yourman, is that deep breathing is good for stress relief. And, of course, if you're a smoker, the single most important thing you can do before surgery is to quit.
Learn how to load up your plate
“Surgery increases stress on your body, depleting it of important nutrients, which impacts the way that your body responds to healing,” explains Cordialis Msora-Kasago, registered dietitian, nutritionist and spokesperson for the Academy of Nutrition and Dietetics. She suggests building up a reserve to buffer the impact. You don't have to scarf down energy bars or dump heaping tablespoons of wheat germ into you're a.m. smoothie; simply maintain a well-balanced diet that includes fruits, vegetables, fiber and lots of lean protein, the building block for muscles. “Studies show that elderly patients can start to lose muscle in as little as three days when they're on bedrest,” Msora-Kasago says. “There's also a lot of evidence that having carbohydrate drinks three to five days prior to surgery may help optimize recovery,” Ko adds. “Talk to your surgeon to see if you should try them to help store short-term energy.”
After your procedure, Ko cautions, realize that “pain medication and anesthesia from surgery can cause constipation.” Down fiber (aim for 25 to 35 grams a day) to stay regular. If you can't reach that goal from diet alone, pop a fiber supplement and follow it up with plenty of water — six to eight glasses a day. Vitamin C, when combined with zinc (pumpkin seeds are a good source), can also help build collagen to aid the healing of surgical wounds, Msora-Kasago notes.
Prevent postop delirium
Defined as a temporary state of confusion and disorientation that may occur shortly after surgery, postoperative delirium varies with age (older patients are more at risk) and the type of surgery. It affects about 5 percent of patients who undergo cataract surgery, for instance, but up to 50 to 60 percent of adults over 70 who have vascular or orthopedic surgery for something like a hip fracture, Yourman says.
"We're finely tuned machines who do things throughout our day that maintain our normalness,” observes Michael Englesbe, a transplant surgeon and professor of surgery at the University of Michigan. “When you have surgery, it's essentially a huge reset on all of those things. Everything gets out of whack.”
Retain some sense of familiarity by packing a well-organized bag containing a few objects from home — maybe a favorite blanket or pictures. Also, be sure to bring any hearing aid or glasses with you, as these can help you stay attuned to your environment. And be sure to rally friends and family to be with you as much as possible at the hospital; experts say these close relationships can be key to reorientating yourself to your environment by reminding you of who you are, where you are and why you're there.
Finally, before surgery, have an honest conversation with your doc about all of the medications you're taking, including over-the-counter drugs. “Some patients are on a half-dozen medications; then doctors throw another half-dozen in there around the time of surgery,” Englesbe says. “That cocktail of medications can cause havoc on people's brains.” Medications that are sedating, such as benzodiazepines for anxiety and insomnia, and some antihistamines, can be problematic, warns Heidi Wierman, a geriatrician affiliated with Maine Medical Center in Portland. What's more, if you take Xanax every day, but only cop to taking it every once in a while, you may struggle if you don't have that medication after your surgery.
Stave off stress
Yes, there really is something to the belief in the power of positive thinking. A 2018 French study, for one, found that among patients undergoing colorectal cancer surgery, those who were more satisfied with their life before surgery had fewer complications after it and a shorter hospital stay. “Patients who bring a positive psychological momentum into surgery do better,” Englesbe says.
Cutting down on the anxiety surrounding your upcoming procedure can help, too. “Often patients feel stressed before surgery because they don't know what to expect,” Ko notes. “When questions are answered — What's going to happen before surgery and immediately afterward? How long are you going to be in the hospital? What's the incision going to look like? — anxiety levels go down.” So don't be shy to speak up and ask questions, even if it means making more appointments with your doctor ahead of your procedure.
Another way to put your mind at ease: Choose a proxy to speak for you and make decisions aligned with your preferences as you undergo surgery. In addition, make sure the proxy has a copy of your living will.
Finally, prepare for potential postsurgical headaches. “The logistics of life — worrying about who is going to take the dog for a walk or cook dinner when you're down and out for a month — are some of the most stressful things,” Englesbe says. “Put a care team in place — two or three individuals to help with your recovery when you're recuperating at home. Patients need to accept that love."