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Older patients recover from surgery faster if they ‘train’ for it

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A person who’s jittery before a surgery might be told by a relative or friend to try to forget about it.

But recent studies and work at hospitals across the country suggest people, particularly older patients, should do just the opposite. To save money and hasten recoveries, evidence shows, they should mentally and physically prepare to be on the operating table.

“You train if you go on a hike or run a 5K race,” said Dr. Michael Englesbe, a professor of surgery at the University of Michigan. “But we never train our patients for their operations.”

That’s changing.

At the University of California San Francisco’s Surgery Wellness Program, older patients gear up for surgery by meeting with dieticians, physical and occupational therapists. The program will soon launch a digital app called Prehab Pal, in which algorithms prescribe older patients a plan to prepare for their surgery.

“You train if you go on a hike or run a 5K race. But we never train our patients for their operations. “
-Michael Englesbe, a professor of surgery at the University of Michigan

The Michigan Surgical Health Optimization Program at the University of Michigan encourages patients to take walks, practice breathing exercises and eat certain foods in the days before their procedure. An early study of these participants found they saved an average of $2,308 in hospital costs compared with other patients.

So how do a few laps and some extra protein add up to saving thousands of dollars?

A recent report that studied the impacts of Duke University Medical Center’s surgery preparation program for seniors offered some answers.

The older patients in the study — all undergoing abdominal surgery — spent four days in the hospital, compared with six days for people who didn’t prepare. Roughly 62 percent of patients who didn’t prep needed home health care after leaving the hospital; among those who did prepare, only 51 percent needed home health care.

Patients who prepped were also less likely to land back in the hospital.

“Prep is as important if not more important than the surgery itself,” said Dr. Ronnie Rosenthal, chair of the American College of Surgeons Geriatric Surgery Task Force.

Because it can be hard to find the resources, and there are challenges to billing Medicare for this work, many of these innovative efforts around presurgery care are still limited to larger hospitals.

Yet experts say much of the preparation can be undertaken anywhere. (You should, of course, always consult with your doctor first).

1) Start planning early

Shelley McDonald, assistant professor of internal medicine in the geriatrics division at Duke University Medical Center, said older patients ideally should start prepping for surgery four weeks in advance.

McDonald said patients should ask themselves: “Is there anything you can think of that will be a barrier when you get home?” For example, some patients might go food shopping and do laundry before they enter the hospital to make life easier when they return home.

Patients should also ask their surgeon how their mobility will be affected by surgery (Will they be able to walk up the stairs?) so they can have a wheelchair or walker waiting if need be.





Having a second pair of ears present when the doctor is giving information about recovery can help ensure directions are followed, especially if the patient has hearing difficulties or confusion.

“We have some older people say ‘I don’t want to bother my family.’ No, this is the time you need them there,” McDonald said. “If the family isn’t there to hear what’s involved, the person might not be able to relay it effectively.”

2) Take walks

Walking in the weeks before surgery can help a patient get back on their feet sooner after the operation, Englesbe said.

“It uses core muscles, which are the ones you use to get out of bed after surgery,” he said.

Patients should buy a pedometer and try to gradually increase their steps as their surgery date approaches, Englesbe said. This will strengthen patients’ legs and respiratory system, particularly their lungs and diaphragm.

If it’s cold out, patients can walk around inside their house or at a fitness center to avoid falls.

“If they have any balance problems whatsoever they should avoid unsteady ground or any ice and snow,” he said.

For older patients particularly worried about their balance, Dr. Clifford Ko, principal investigator of the Coalition for Quality In Geriatric Surgery, recommends building strength by sitting up and down in a chair.

“If they can do it pretty easily four or fives times a day, that’s terrific,” he said.

3) Cut out vices

After surgery, many older patients won’t have an appetite because they’re nauseous from pain medication, Ko said.

“We starve our bodies after a surgery,” he said.

Therefore, older patients should make an effort to eat as healthily as possible prior to their operation. It’s often recommended that older patients eat smaller, more frequent and protein-rich meals beforehand.

“A patient should ask their surgeon what they should expect and how much nutritional reserve they should have before their surgery,” he said.

“The smoke displaces oxygen and we need oxygen to heal. “
-Dr. Clifford Ko, principal investigator of the Coalition for Quality In Geriatric Surgery

Ko said patients should also stop smoking eight weeks before their surgery to decrease their chances of getting pneumonia after. Smoking can also prolong healing time.

“The smoke displaces oxygen and we need oxygen to heal,” he said.

Likewise, avoid alcohol before your procedure. It can increase your chances for bleeding and postoperative delirium, in which older patients become confused after surgery. Patients should also review their medications with their doctor.

4) Prepare mentally

Dr. Gretchen Schwarze, a vascular surgeon and medical ethicist at the University of Wisconsin in Madison, said many older patients are blindsided by the aftereffects of surgery.

“As surgeons we’ve been taught to talk about benefits and risks,” she said. “Although those things are informative, they don’t prepare you for what surgery is like.”

Schwarze recommends that patients ask their surgeons: What can I expect after? What will my life be like a week after surgery? Three months after? A year after? How will surgery affect my other health problems?

“You can integrate those answers into your life,” Schwarze said.

Patients should also understand that recoveries are complicated.

“Surgery doesn’t fix the problem and make you like you were before,” Schwarze said. “You may be better off, but you are never going to be the same again.”

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