If you have ever had surgery you are probably familiar with rehabilitation, but what if you could do some simple things before surgery to make your recovery afterwards easier and faster? You can.
At Carilion Clinic, surgeons are utilizing a special protocol that greatly increases their patients’ ability to recover after surgery. The program is two-fold, consisting of prehabilitation and what is called enhanced recovery protocol (ERP). Together, the programs consist of approximately 30 steps, many of which the patient is actively involved in.
The first step – prehabilitation – happens before a patient even steps foot in the operating room. Patients attend a special class where they learn what they need to do before surgery to help aid in recovery after surgery. But even if your health care provider does not have a special protocol in place, there are several things you can do on your own to enhance your recovery. According to Sandy Fogel, M.D., of Carilion Clinic’s Surgery Department, patients are asked to focus on six basic things before surgery to improve their recovery.
It is always a good idea to eat a healthy diet, but prior to surgery it is especially important. According to Dr. Fogel, patients are instructed to drink a special supplement three times per day for five days before surgery.
“We want to make sure our patients are as well nourished as they can be before they go into surgery,” he said. “And this specific supplement has the right mix of amino acids that are essential for wound healing.”
If you don’t have access to this special amino-acid infused drink, focus on increasing your intake of lean, healthy protein before surgery since it is essential for healing.
2. Carb load
To improve their performance before an endurance event, athletes increase the quantity of carbohydrates they eat to increase the amount of fuel stored in their muscles. This is known as carb loading. So, just as an athlete might carb load before running a marathon, our surgeons carb load their patients because surgery is a stress on the body much like a marathon would be.
Patients are given 25 grams of a special carb-rich drink eight to ten hours before surgery and another 25 grams two to three hours before surgery. Patients are also allowed to have clear liquids such as water, broth, Jello, or tea up to two to three hours prior to surgery.
“Not only are their bodies ready to handle the stress of surgery, they also come to the hospital less thirsty, less dehydrated and less starving,” Dr. Fogel noted.
No special carb drink? No problem. Just add some additional healthy carbohydrates to your meals a few days before surgery. Diabetics, however, should watch their carbohydrate intake and carefully monitor their glucose levels.
Even for patients that are total couch potatoes, moderate exercise before surgery can make a difference in their post-op recovery. Dr. Fogel asks his patients to go for short walks three or four times per day for a week prior to surgery.
“Just moving and getting their muscles going makes it much easier for them to do it after surgery,” Dr. Fogel noted. “The ability to get out of bed and move around after surgery helps prevent conditions such as blood clots, pneumonia, muscle wasting and overall it keeps the patient stronger and makes their long-term recovery easier and faster.”
4. Oral care
Brushing your teeth, using mouth wash, and flossing for a week before surgery greatly cuts down on the amount of bacteria in a patient’s mouth; thus, it reduces post-op complications such as pneumonia and wound infections.
“Patients under anesthesia have a tube down their throats to help them breathe. The tube is also a route by which bacteria can contaminate the lungs, causing pneumonia,” Dr. Fogel said. “But when we cut down on the amount of bacteria through good oral care, we cut down on the rate of infections.”
5. Expanding the lungs
After an operation, it is often the norm for patients to perform deep breathing exercises, but it is actually more effective to perform these exercises before surgery as well.
“When you are in pain, you tend to take shallow breaths, but if we have expanded a patient’s lungs fully beforehand it is easier for them to take deep breaths afterwards,” Dr. Fogel noted. “This not only helps them breathe better after surgery, but it also decreases the risk of pneumonia.”
For about a week before surgery, patients are instructed to take big, deep breaths ten times in a row three times per day. Each breath is held for about five or six seconds.
Statins are normally prescribed to lower cholesterol, but for patients at high risk for a cardiac event, statins help decrease their risk regardless of their cholesterol level.
“As little as seven days on a statin before an operation will decrease the rate of cardiac events after surgery,” said Dr. Fogel.
The statin prevents platelets from clotting or aggregating on cracked plaque, a leading cause of stroke or other cardiac related events.
Enhanced Recovery Protocol
Once the prehabilitation program is complete, patients are primed and ready for surgery, during which, enhanced recovery protocol, or ERP, is enacted. ERP is a collection of evidence-based best practices in protocol format around the surgical experience. ERP includes several steps that are put into action by our staff. One such example according to Debbie Copening, M.S.N., R.N., C.N.O.R., senior director of Surgical Services Quality, is the use of other pain medications in place of narcotics.
“It is called multimodal pain management. We will use things like epidurals, nerve blocks, IV Tylenol or a low-dose drip of lidocaine,” she explained. “Patients come out of surgery less groggy, less dehydrated and less nauseated, which means they are able to get up and move around much sooner and they are able to eat much sooner, all of which aids in their recovery.”
And after surgery, much of what the patient did for their prehabilitation program continues. Copening noted that patients will continue with special supplements, breathing exercises and walking.
The special protocol has been in place at Carilion since September 2013, and now, two years later, the data is in and the the program is proving to be a success. The special protocol has improved outcomes, reduced complications, shortened length of stay and increased patient satisfaction. For example, the national average for a hospital stay is 10 days.
Before the program, our average for patient stays was 9.6 days. Now, for patients undergoing the protocol, the average length of stay is five days with most patients going home on the third day. Dr. Fogel noted that these patients are going home eating, walking and doing everything they would ordinarily do.
The program also decreases readmission to the hospital for complications and it decreases the need for patients to recover in a nursing home or a rehab facility, allowing more patients to recover in the comfort of their own homes. But, according to Dr. Fogel, the most telling result is when patients that have had surgery prior to the prehabilitation program tell him how much easier it was for them to recover this time around.
To find out more about the steps you can take prior to your surgery to ease your recovery afterwards, talk to your doctor.