Surgeons are taking more steps to improve patient outcomes in the OR – starting weeks before they go under the knife. Doctors are learning the benefits of boosting patients’ health in the crucial weeks between a diagnosis and surgery and taking the time to get their patients in better shape.
Leading the charge is Strong for Surgery, a group out of Washington State that has joined with partners including the American College of Surgeons to provide preoperative checklists focusing on risk factors that can be modified before surgery. The checklist focuses on four issues: smoking, nutrition, blood sugar control and medication. Smoking, for example, can impair the ability to withstand anesthesia, increase the risk of respiratory complications after surgery such as pneumonia and interfere with wound healing.
The Strong for Surgery checklist also suggests that patients who are poorly nourished can benefit from a nutrition formula, sold by Nestlé SA and others. It can be provided for five days before a procedure, boosting the immune system to fight off bugs. In addition to checking diabetes patients’ blood-sugar control, checking blood sugar for those over 45, or less than 45 with a high body mass index is recommended so any needed treatment can be started before a procedure.
The Strong for Surgery checklist also includes a recommendation that patients and doctors review all medications, including herbal remedies that patients may not think to disclose. Ginkgo biloba for instance, can cause bleeding problems and hormone therapy can increase the risk of blood clots after surgery.
Are You Strong Enough for Surgery?
Here are some health issues that might prompt doctors to postpone a procedure, and the corresponding surgical complications.
- Nutrition: Poor nutritional status is linked to post-surgical infections; low levels of the protein albumin are associated with higher complication rates.
- Blood-sugar control: Elevated blood sugar from diabetes or prediabetes increases risk of surgical-site infections and poor healing.
- Smoking: Increases the incidence of pulmonary complications after an anesthetic as much as sixfold and can complicate lung function, wound healing and cardiovascular health.
- Medication: Abrupt withdrawal of some medications can lead to postsurgical complications; continuing other medications such as blood thinners can raise bleeding risk.
- Heart attack: Having surgery within two months of a heart attack is associated with elevated risk of another heart attack and death.
- Alcohol: Excessive use of alcohol may lead to more complications and infections.
- Fitness: Patients with limited exercise capacity have higher risks of cardiac complications during or after surgery.
Source: Strong for Surgery; Mayo Clinic; American College of Surgeons and “Need Surgery? You Might Have to Get Healthier First” Wall Street Journal