Whether minor or major, emergency or elective, inpatient or outpatient, millions of Americans undergo surgery every year. Generally speaking, most people don't like to think too deeply about what's going to happen, an approach psychiatrists call "denial." But being prepared--physically, emotionally, and practically--for a surgical procedure can make a huge difference. Many of those who have successful surgical experiences report that they used their operations as an opportunity to learn about their body, to get closer to family and friends, and even to discover a new (and often unexpected) healing power within themselves.
To begin, if you've been told that you should consider surgery, there are several strategic areas you'll need to address:
Quality control
Research, as well as common sense, shows that the caliber of the surgeon and hospital can make a significant difference in a surgical outcome. A lot can be learned simply by asking the right questions. You might start with some basic research on the Internet. Ultimately, though, your best sources of information are your primary-care doctor and your surgeon.
Surgeon quality. Complex operations, such as a coronary bypass or the removal of certain cancers (lung and kidney, for example), are best left to a doctor who has done them repeatedly--a so-called "high volume" surgeon. One study estimated that as many as 13 out of every 100 deaths from risky surgeries could have been avoided if the surgeon had had more experience. Don't be reluctant to ask about your surgeon's experience with a particular procedure; surgeons are now accustomed to being queried about their records.
Hospital quality. Something as simple as hospital size and organization can make a big difference. Research shows that busy surgical-care hospitals have fewer deaths among patients undergoing complex procedures than do facilities less practiced at the procedure. Most likely, that's because these hospitals tend to have high-volume surgeons and nurses familiar with postoperative care as well as specialized support services.
Minimally invasive surgery
Also known as
laparoscopic surgery, minimally invasive techniques began to appear in the late 1980s and are now widely used. Instead of making large incisions, a surgeon does very small ones, inserts miniature cameras and instruments, and completes the surgery while watching a monitor. First used to remove gallbladders, laparoscopic techniques are today employed for abdominal, gynecologic, neurologic, vascular, and oncologic (cancer) surgery.
It's worth checking to see if your particular operation can be performed laparoscopically, even if you have to travel to another hospital or find another surgeon. The benefits are many: Incisions are tiny, pain is much less, and healing is usually faster. The risk of blood loss or infection is also reduced. Best of all, your return to normal activity is much more rapid.
Mind-body techniques
Many studies have shown that when patients participate in their own care, their overall results improve dramatically. Mind-body techniques, such as guided imagery and self-hypnosis, are easy to do, safe, effective, and very empowering. A variety of self-help books and audiotapes can quickly teach you mind-body therapies that are effective for any elective operation.
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There are several different types of surgeries, each with its own defining characteristics.
Elective surgery (scheduled by patient), inpatient: Usually done in the hospital, where the patient stays for one or more days following the operation.
Elective surgery (scheduled by patient), outpatient: Takes place in a hospital, doctor's office, clinic, or surgical center. Also called ambulatory or "same-day" surgery. Patient arrives and returns home the same day.
Emergency surgery: Necessary following acute trauma and in certain cases of sudden and major catastrophe, like a perforated ulcer or ruptured appendix. Often done in a center where care is coordinated between the emergency department, the operating room, and the intensive care unit (ICU).
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Preparing intelligently for surgery involves asking many questions, and then determining what your best course will be. It's also important to focus on strategies that will help you handle your fears and speed your healing. Take time to educate yourself about what is being proposed; the well-informed and proactive patient simply has better overall results. Learn about your body, what's going to be done, and check out the surgical team and hospital. Sample queries might include:
Questions about the operation
Why do I need this operation--and do I really need it? (Surprisingly, many people consent to surgery without this basic data.)
What exactly is going to be done to me?
What can I realistically expect from this surgery? (Many people are disappointed with surgical results because they didn't have a clear picture of what gains to expect.)
Are there alternatives to surgery? Would minimally invasive techniques work for this condition?
What kind of anesthesia will I need? Can this be altered in any way?
What are the risks?
How long is recovery likely to take? When can I expect to return to my normal activities?
How much will the operation cost? Has pre-authorization been obtained from my insurance company? (This is often overlooked and people spend months trying to get their expenses covered.)
What are the consequences of delaying, or even avoiding surgery altogether?
Important point: Unless your surgery is an emergency, get a second or even third opinion. Your doctor, surgeon, local medical society, and health insurance plan may be of help here.
Questions for the surgeon
How often do you do this procedure? A good rule of thumb for a major (complex) operation would be to find a surgeon who does 50 to 100 cases a year. This high volume is probably not necessary for less complex surgeries, such as a knee replacement.
What is your complication rate and success rate for this specific procedure? (Remember, some surgeons' high mortality rate may be because the very best surgeons are operating on especially sick, high-risk patients to begin with.)
How experienced is the support team who will be caring for me in and out of the operating room? Successful surgery depends not only on the surgeon but the anesthesiologist, nurses, technicians, and consulting physicians.
Don't be reluctant to run a short background check on your surgeon, no matter how prestigious the hospital. Information about professional disciplinary action, licensing, and previous malpractice problems is readily available on the Internet.
To prepare for surgery: For most major procedures you'll be asked to avoid eating or drinking 8 to 10 hours before the operation. You'll be reminded to remove items such as jewelry, dentures, and hearing aids. Give your valuables to a family member or have them placed in the hospital safe.
The obvious next steps are handled by the surgical staff: You'll be asked to empty your bladder and bowels. Then you'll disrobe and be given a gown and a cap to cover your hair. The area to be operated on will be cleansed and shaved. The nurse or anesthesiologist will likely insert an intravenous (IV) needle into your arm, to allow for quick delivery of medications or blood or other fluids during and after the operation.
After the surgery, you'll be rolled into a recovery area until the anesthesia wears off. You may awaken with a face mask that's delivering oxygen or with a tube in your bladder draining urine. You won't feel particularly well. You may be chilly, tired, groggy, headache-y, weak, and nauseous--all are common reactions that fortunately don't last very long.
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Modern medicines have revolutionized surgical care--before, during, and after the operation itself.
Before surgery
Review with your surgeon all the prescription medications, over-the-counter medications (including daily low-dose aspirin), and nutritional supplements you regularly use. Don't omit anything that you've taken during the few days leading up to surgery that might still be in your body.
On the other hand, don't start or stop a medication on your own, without checking with your doctor first. If you're unsure, bring the medicine bottle with you. And always discuss any known allergies or past problems with medications.
During surgery
Anesthesia is used to blunt or block pain, and it's rightfully considered one of the blessings of modern medicine. The type of anesthesia you receive depends on such factors as the state of your health, the kind of operation that's planned, as well as your wishes and requests. While anesthesia poses some risk, it's typically pretty safe these days. Talk to your doctor if you have concerns.
There are several types of anesthesia:
Local anesthesia is given by a needle shot into a confined area; it numbs pain but not feelings of pressure.
Regional anesthesia blocks feeling in a region of the body; a shot given in the lower back numbs the pelvic area, for example.
General anesthesia causes unconsciousness; typically a mask is placed over the nose and mouth to deliver oxygen, and then an anesthetic is delivered through an IV line. During unconsciousness, people are still able to process auditory information on some level. Recent research shows that general anesthesia, while relaxing the muscles, does not stop nervous system reflexes from unconsciously reacting to pain signals. Consequently, more anesthesiologists and surgeons are combining local and general anesthesia to improve post-op pain outcomes.
After surgery
Pain is a normal part of the healing process. That said, many doctors have recently been criticized for failing to provide adequate pain relief.
Powerful painkilling medications can make pain a non-issue, and because they're used for such a relatively short time, addiction is virtually impossible. Unrelieved pain will only increase stress and slow healing. If you're in significant pain, talk to your doctor about it.
A patient-driven method called Patient-Controlled Analgesia (PCA) may be available; ask your doctor about it before the procedure. After surgery, you may also be given antibiotics to help ward off infection.
In addition, certain mind-body techniques may be referred to as behavioral anesthesia. Using such therapies as guided imagery or hypnosis has been shown to help control surgery-related pain and to minimize the use of pain medications during recovery. (See Alternative Therapies below for more information.)
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Before ever entering an operating room, all surgical patients are assessed and medically "cleared" for the procedure. A health history is taken and routine tests are run, including urinalysis, chest X-ray, electrocardiogram (ECG; to test heart function). Throughout the surgical process, the medical team will do periodic tests of temperature, pulse, and blood pressure.
For major inpatient surgery, you may want to donate your own blood beforehand to replace any that you might lose during the operation. Doing this helps to ensure a safe and precise blood match. Ask your doctor about scheduling this far enough in advance so that your system can recover and make enough blood again before the operation. (Be sure to tell your doctor if your health changes in any way before surgery; even a minor cold can alter blood quality.)
Many patients have found that the stress and anxiety of testing and other presurgical procedures can be easier to handle when mind-body techniques such as guided imagery and relaxation are used as well. Finally, make sure to take all your current test results with you from one locale to another so that tests aren't unnecessarily repeated (often at some expense to you).
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Surgery is almost always necessary--and often lifesaving--after a major trauma, such as an automobile crash or bullet wound injury. A skilled surgical team often can stop life-threatening bleeding, save a limb or other body part, preserve internal organs from further damage, and keep basic body functions going.
There are also some acute conditions--appendicitis is a good example--for which experts agree that surgery is almost always necessary; there is simply no better cure. In most cases, malignant tumors and cancers also need to be surgically excised to give the best chance for meaningful survival.
A number of elective surgeries are now done less frequently. For example, many surgeons are now careful about performing surgery for hernias of the male groin because only a small percentage become serious enough to warrant intervention. Other surgical procedures that are on the decline include knee arthroscopies, sinus and back surgeries, hysterectomies, and stroke prevention surgery (carotid endarterectomy).
To Prevent Complications Of course, surgery still provides a valuable option for many conditions. Once you've decided to go ahead with a procedure, some of the following practicalities may help to prevent complications:
Quit smoking, even if it's just two weeks before the surgery. General anesthesia briefly alters your lung function, which is why stopping smoking will enable you to better tolerate the medication and reduce the risk of infection.
Mark the spot. A recent U.S. survey of hand surgeons found that one-fifth had operated on the wrong site (finger, hand, wrist) at least once in their careers. In other words, wrong-site procedures are more common than you'd think. Have the surgeon clearly initial the intended surgical site. Ask that the surgeon verbally verify the site and procedure before making a cut. As a patient, you can even ask about marking the opposing body part "Wrong!" (Just don't use an "X," as this can cause confusion.)
Watch your timing. Try to avoid elective surgery any time near major holidays when hospital staffs are depleted and experienced senior doctors are often out of town.
Maximize your stay. If you feel you are being pressured by your insurance company to be discharged from the hospital and feel it's premature, let your doctor know. He or she can usually finagle an extra day or two. The hospital social services department can help arrange postoperative home care, like visiting nurses. Without prior authorization, however, you'll be responsible for the bill.
Get briefed. Finally, before leaving the hospital, make absolutely sure that you are clear on what you can and can't do in the coming weeks in terms of your activity level, diet, and medicines. If you need extra help at home, the hospital's social services department can arrange for a nurse or physical therapist to visit you on a daily basis.
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As the use of dietary supplements has increased, so have reports of possible side effects during surgery. While some concerns may be overblown, be sure to talk to your doctor, surgeon, and anesthesiologist about all the supplements you take or plan to take as you recuperate; they may have specific recommendations.
Just a reminder: If you have a serious medical condition or are taking medications, always talk to your doctor before starting a supplement regimen.
Before surgery
Start taking a high-potency multiple vitamin/mineral the moment you know you're going to have surgery. Look for a formulation with extra B vitamins and magnesium, which are helpful for combating stress--and that certainly includes surgery.
Zinc and vitamin C are needed to form the healthy collagen that repairs wounds. Flavonoids will help to limit scarring. Some doctors recommend taking iron before surgery to help your body replace any blood that's lost during the operation. If you're having heart or gum (oral) surgery, adding coenzyme Q10 before and after surgery is also a good idea.
Special Note: Supplements to Avoid A number of commonly used herbs--as well as vitamin E--can interfere with blood clotting and anesthesia, so discuss all supplements you're taking with your medical team. Avoid the following herbs for two to three weeks before surgery.
Echinacea may interfere with wound healing, and could possibly lead to liver inflammation when combined with certain drugs.
Ephedra (ma huang) may cause heartbeat irregularities and problems with blood pressure and/or heart rate.
Feverfew may interfere with blood clotting and increase the risk of bleeding.
Garlic may increase the risk of bleeding.
Ginger may increase the risk of bleeding when taken in supplement (high dose) form, but can be useful after surgery to control nausea.
Ginkgo biloba may increase the risk of bleeding; stop taking it at least 36 hours before surgery.
Ginseng (Panax ginseng) could increase the risk of bleeding and interfere with anticlotting medications. It has also been linked to rapid heart beat and elevated blood pressure in a surgical setting. Low blood sugar is also a potential risk.
Goldenseal may cause swelling or increased blood pressure.
Kava may increase the effects of anesthesia or contribute to liver problems.
Licorice may elevate blood pressure or cause electrolyte imbalances.
St. John's wort may intensify the effects of anesthetic medications and can interfere with the metabolism of many drugs used before and after surgery.
Valerian may increase (and possibly prolong) the effects of anesthesia.
After surgery Your body will be rebuilding a lot of tissue (including skin, muscle, and internal organs), and it's important to support and encourage this healing process. A
protein powder or capsules of
mixed amino acids (protein building blocks) will help ensure that your body has the raw materials it needs during your recuperation.
Bromelain, a group of powerful protein-digesting enzymes derived from pineapple, may help to reduce tissue inflammation, swelling, tenderness, and pain. Siberian ginseng can help the body withstand the stress of surgery. After the dressings are removed, the oil from vitamin E capsules can be rubbed on the scabbed over wound to reduce scarring.
If you are prescribed antibiotics, they will likely disturb the normal bacterial balance in your intestines. Probiotics (look for a mixture of acidophilus and bifidobacteria) can help restore the internal bacteria to their normal, healthy state.
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The operation itself, and the healing time that follows, place extraordinary demands on the body. From the moment you learn you need an operation, start preparing yourself. Key areas include emotional and practical support, relaxation, positive healing statements, and sound nutrition.
Emotional and spiritual support
Maximize your healing potential by surrounding yourself with love and support.
Bring a friend or family member to every doctor's appointment.
Reconnect with people who care about you, and ask them to think of you or pray for you while you are in surgery. Studies have shown that prayer speeds recovery of hospitalized patients. More about the value of such support is included in Peggy Huddleston's
Prepare for Surgery, Heal Faster program; see
"Preparing for Surgery with Mind-Body Techniques." Consider short-term psychotherapy if anxiety is overwhelming you. A therapist may provide valuable advice to help you cope.
Practical support
Especially during recovery, it's important to have people helping you out.
Make sure beforehand that someone will assist with meals, walk your dog, clean your house. If you anticipate briefly needing physical help moving around (up the steps into your house, for example), ask family, friends, and neighbors to lend a hand.
Take enough time off. People who give themselves more time to recover initially, end up doing better in the long run.
Relaxation techniques
There's overwhelming data that deep relaxation can improve the functioning of the heart, immune system, and nervous system, all important factors as you prepare for and recover from surgery.
Aim for a profound level of relaxation, and tap into whatever helps you best achieve it--be it yoga, meditation, prayer, biofeedback, or guided imagery (see Alternative Therapies below). Maybe just listening to music will do the trick.
Consider using audiotapes and CDs specifically created to help you deal successfully with surgery. Materials produced by trained psychotherapists like Belleruth Naparstek or Peggy Huddleston are well regarded. Most require listening and practice beforehand, which enables the material to be effective even if you are under anesthesia. Most surgeons will allow you to listen during the entire operation.
Positive reinforcement
Even under general anesthesia, your auditory system continues to function.
Ask the surgical team to make positive therapeutic statements about your progress during the operation. Such upbeat remarks have been shown to improve the chances of a successful outcome.
Focus on repeating similar positive statements--called healing affirmations--directly before and after the operation.
Good nutrition
What you eat is important both before and after surgery in helping your body to prepare for and recuperate from the procedure. Focus on your food choices as soon as you know you'll be having surgery; dietary change is much easier before you're dealing with the aftereffects of an operation.
Include high-quality, low-fat protein sources (poultry, fish) as well as soy products. Adequate protein is necessary for wounds to heal properly.
Aim for a diet that includes whole grains and legumes for fiber and plenty of fresh fruits and vegetables.
Avoid "empty" calories from junk foods and sugar, and skip foods high in saturated fat. All of these can impede good wound healing.
Reduce your caffeine intake before (as well as after) surgery, because caffeine can interfere with wound healing.
Don't worry about going on a weight loss program right now, unless obesity is increasing your surgical risks (and the latest findings indicate that it usually doesn't).
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Literally hundreds of research studies have shown that simple behavioral interventions (such as psychological counseling), and certain alternative therapies (such as guided imagery) can greatly improve the success of nearly any surgery.
Benefits from some of the most effective behavioral interventions include less blood loss during surgery, reduced need for pain medication, fewer surgical complications, quicker recovery after surgery, shorter hospital stays and dramatically less nausea.
A few of the alternative therapy strategies to consider prior to surgery include:
Guided imagery. With this technique, the imagination is consciously stimulated to create "healing visualizations," which in turn produce positive healing changes in body and mind. This approach works, research shows, because picturing something and actually experiencing it are equivalent in terms of brain activity.
Numerous studies have demonstrated the power of guided imagery in preparing for and recovering from surgery. The data have been so convincing that certain health insurance carriers (Blue Shield of California is one) have started to distribute guided imagery how-to tapes to members who are scheduled for major surgery. The hope is that the pain and anxiety associated with surgery will be eased, surgical complications lessened, and hospital stays shortened.
One guided imagery technique experts suggest is to visualize yourself after the surgery, healed and happy. You'll need to dwell on these healing images several times a day, letting them permeate your consciousness. The most effective images are linked to a specific physical outcome, such as cells rebuilding, bleeding being minimized, or bone and skin being knit together to heal.
Hypnosis. The origins of hypnosis date back to the ancient Chinese and Egyptians, who used it in religious rituals and recognized the power of the mind to heal. Today, hypnotherapists continue to help patients access their subconscious mind, and, in the case of surgery, dramatically reduce related stress. Patients who have been hypnotized before surgery undergo a procedure with the belief that they are in control and that things will go well, and generally they do. In fact, research in this area has been so encouraging that, at Columbia-Presbyterian Medical Center in New York City, groundbreaking mind-body work in the cardiac surgery unit now involves patients consulting a staff hypnotherapist prior to surgery.
Acupuncture. This ancient but still widely practiced healing technique involves the insertion of hair-thin needles into specific parts of the body. Results of research on acupuncture for pain reduction and nausea following surgery have been impressive. After evaluating hundreds of studies, an advisory panel for the National Institutes of Health (NIH) declared it an effective treatment for postoperative pain after dental surgery and for nausea induced by anesthesia or chemotherapy. In addition, an experienced acupuncturist can help re-establish hormonal and menstrual cycling after pelvic surgery.
Energy healing. In this mind-body approach, practitioners channel or "conduct" healing energy through their hands and into the patient, clearing any blockages in the person's energy field and helping to build up the patient's own curative energy. Energy healing techniques such as
healing touch, therapeutic touch, and Reiki, are just a few of the energy healing techniques being used today. Therapeutic touch has been shown to increase blood hemoglobin levels in hospital patients. Reiki is believed to aid the body's innate ability to heal itself, and a small preliminary study showed that it was useful as an adjunct to opioid drug therapy in the management of pain.
For more information on these modalities, see the specific entries in the WholeHealthMD Reference Library.
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If you need help coping with presurgical anxiety or tension or are thinking about canceling the operation.
If you would like another opinion on whether to proceed.
If you are unable to cope physically or emotionally following discharge from the hospital.
If you develop signs of a complication, such as excessive pain, uncontrollable bleeding, or signs of infection (fever, red streak marks or pus from the wound).
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