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Shields up! Safeguarding your health post-surgery


man holding shield

In medicine, we deal with whatever comes in the office or emergency room door, confronting one issue after another and extinguishing fires as they erupt.


Our current medical system places an overwhelming emphasis on treatment and rescue, rather than prevention. Of course we try to detect cancer early, prevent heart attacks, support individuals in quitting smoking, and suggest healthy eating plans – but a significant chunk of our efforts goes into attacking immediate problems. Our focus leans towards reaction, rather than prevention.

So how does this dynamic translate to the field of surgical recovery? In the battle against post-op complications, are we balancing treatment and prevention? Do we have only a sword to react with, or do we also possess a protective shield to ward off harm?


The Surgical Sword: Reacting to Post-Op Issues

As the saying goes, if you spend enough time in a barber's chair, you're bound to get a haircut. Likewise, when you consult with a surgeon, it often culminates in a surgical procedure.

By its very nature, surgery involves intervention. Surgeons employ a range of weapons to address the conditions at hand: some wield scalpels with meticulous expertise while some tap hammers and others harness the precision of lasers.

The primary mission is usually clear-cut: take this out, rearrange that, and put it all back together again. Then watch closely on the wards for any potential complications, and promptly address them when they arise.

This epitomizes the treatment and rescue approach – a field where surgeons truly shine. Regrettably, even within top-tier healthcare systems, the occurrence of complications following major surgery remains a significant concern.

To illustrate, a comprehensive UK report from 2018-19, which reviewed nearly 20,000 surgical procedures, documented an adverse event rate of 23.8% afterwards. This represented a modest improvement compared to the preceding year.

Furthermore, data from an American database encompassing 256,251 colorectal procedures from 2009-11 disclosed an astonishing statistic: 40% of patients had adverse events during their hospital stay.


These complications don’t necessarily arise from errors or mistakes, although some of them could have. Most arise simply because surgery is inherently a high-stakes undertaking, fraught with potential complications, even when performed perfectly under ideal circumstances.


Surgery is inherently a high-stakes undertaking,

fraught with potential complications.


So when unexpected events – that is, complications – appear, we physicians can wield our surgical swords to swiftly respond, just like in the classic whack-a-mole game. But what preventive mechanisms have we established to shield ourselves from these setbacks?

As Benjamin Franklin wisely quipped, 'An ounce of prevention is worth a pound of cure.' Clearly, when it comes to surgery, shouldn't we adopt a similar approach?


The Surgical Shield: Preventing Post-Op Issues

Patients, healthcare providers, hospital administrators, and insurers share a collective goal: to minimize the occurrence of post-operative complications as much as possible.


Significant strides in prevention have been made in specific areas, especially in those that are easily manageable. Many preventive measures have now become standard practice, commonly mandated by hospitals or insurers for their simplicity and cost-effectiveness.


These preventive strategies can be categorized into three distinct domains:


1. Basic Prevention Measures

These are the low-hanging fruit - easy, simple, and cost-effective interventions

that play a pivotal role in preventing complications. Examples include:

  • Administering antibiotics and managing blood sugar levels during surgery to prevent surgical site infections.

  • Providing heparin to high-risk individuals undergoing surgery to prevent blood clots.

  • Tailoring anesthetic medications for patients with sleep apnea to minimize respiratory issues.

Status: Widespread Adoption

Quality initiatives, such as the surgical safety checklist, and hospital accreditation programs have demanded almost universal adoption of these simple measures.


 

2. Provider-Centric Preventive Measures

These interventions are more resource-intensive and challenging to implement, often demanding additional staff efforts or incurring higher system costs. Examples include:

  • Mobilizing patients in hospital hallways after surgery to prevent blood clots.

  • Medical optimization of chronic conditions like diabetes or anemia before surgery.

  • Remote home monitoring systems connecting patients and health care providers for weeks after surgery.

Status: Variable Adoption

The success in implementing these strategies can vary widely among individual hospitals. Several factors come into play, such as the presence of local champions to advocate for these programs and administrative priorities regarding resource allocation.


 

3. Patient-Centric Preventive Measures

These strategies are the most challenging, as they rely heavily on patient compliance and surgeons and anesthesiologists may lack the expertise to provide guidance on them. Examples include:

  • Smoking cessation programs before surgery to avoid post-surgery complications.

  • Nutrition screening and weight gain or loss interventions before surgery.

  • Physical fitness assessments and exercise regimens before surgery.

Status: Sporadic Adoption

While many patients may receive a form of "brief advice," the availability of specialized programs and the expertise necessary to guide individuals in achieving these goals remains inconsistent and restricted.


 

Arming Yourself for a Successful Recovery

All these measures are important. In the first two domains, patients must rely on healthcare providers, payers (such as insurance providers), and systems.

Fortunately, when it comes to patient-centric measures, individuals wield more control. Programs targeting smoking cessation, weight loss, fitness, and stress reduction can all be pursued online or within the community by motivated individuals.

This is good news. It means individuals can significantly influence their recovery and they need not depend solely on their hospital's offerings.

The term "surgical prehabilitation" has been coined recently to embody this strategy.



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