Preparing for surgery

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Preparing for surgery

This webpage will provide you with useful information about how you can prepare yourself for surgery. 'Prehabilitation' is all about undertaking good preparation for your body and mind before your surgery. Taking some simple steps to maintain your health and fitness can reduce your risk of complications and improve your wellbeing now and in your recovery. Helping you to "wait well" for surgery.
Watch this short video: https://youtu.be/2CUMpUwX0x4
In the run up to having surgery, there are things you can do to get ready. If you’re in good health you’re more likely to recover better after surgery, have fewer complications and get the maximum benefit from your treatment. Making lifestyle improvements in the following areas can make a real difference to your outcome from surgery and for your health and wellbeing in general.
Click on the links below to find out more.

Acknowledgement: the information on these webpages has been guided and supported by the team behind  www.getsetforsurgery.org.uk .

Wellbeing

Better wellbeing before surgery helps you recover after surgery.

When you’re waiting for surgery, you may feel more worried than usual. Your problems may not seem health related. For example, issues with money, family, or housing can affect your wellbeing.

Wellbeing and your surgery 

Having surgery or treatment can be stressful. We understand that the time leading up to this can be worrying. This can make you feel anxious. It can be bad for your general wellbeing. Feeling stressed and anxious can also affect things like the quality of your sleep.

By reducing your anxiety and improving your wellbeing, you can experience a much smoother journey through hospital. That can mean less pain and a shorter hospital stay. 

It is important to understand that it is normal to feel anxious before a surgery or treatment. 

But there are things you can do to help improve your wellbeing and reduce anxiety.

How do I improve my wellbeing and reduce anxiety?

There are many ways to improve your wellbeing. Different people will find that they have different methods, but some common options are:

  • Exercise: especially relaxing options such as yoga or tai chi.
  • Talking: A problem shared is a problem halved.
  • Breathing exercises
  • Relaxation techniques such as relaxing music, meditation, or mindfulness; These can be guided using apps such as ‘stress and anxiety companion’ on android and Apple stores.
  • Learn something new or take up a new hobby such as cooking or singing.

Top tips to improve your wellbeing

  • Keep in touch with people and talk about your worries.
  • Exercise will help you feel better. A little is better than none.
  • Set a routine with time aside as ‘worry time’ to focus on any concerns. Then move on with your day.
  • Write down your worries or keep a diary before bed. Plan time to review them later.
  • Get fresh air. Sunlight and nature are good for you.
  • Learn a new skill like DIY or cooking. The success of learning can boost your self-esteem.
  • Ask for help if you need it.

Where can I get help in my local area? 

More useful links

Smoking

Stopping smoking really is the best thing anyone can do for their health and to reduce the risk of a bad result after surgery.

The World Health Organisation showed that stopping smoking reduces the risk of complications following surgery by 50%.

Stopping smoking improves the blood supply to tissues, so wounds heal better, with fewer infections and lungs work better, with far less need for intensive care. Within hours, your blood is better at carrying oxygen round your body.

Smoking and your surgery

Quitting smoking is the best thing any smoker can do to improve their current and future health.

Stopping smoking before surgery means your heart and lungs don’t have to work so hard. This makes it easier for your body during and after your surgery. It improves your chances of a smoother and faster recovery and can reduce your amount of time in hospital.

If you stop smoking 4-6 weeks before your surgery, you will have better results.

But it is never too late. Stopping even a few days before your surgery is good.

Top tips for stopping smoking

If you smoke, quitting can sometimes feel scary. Many people try to quit smoking with willpower alone, but it’s much easier with help like quitting aids, vaping and local stop smoking services. There are lots of support options available, it’s about finding a combination that works for you. 

Stop Smoking aids and treatments are easy to buy from shops, pharmacies and on prescription to help you quit smoking. These reduce withdrawal symptoms and keep your mind off smoking.

Ask your stop smoking advisor or pharmacist for advice.

  • Set a date to stop and aim to stop sooner rather than later.
  • Let friends and family know your plans so they can support you.
  • Avoid temptation. Throw away cigarettes, lighters and ashtrays.
  • Change your habits to avoid temptation.
  • Tell yourself you’re a non-smoker.
  • Take one day at a time.
  • Never have the odd one.
  • Congratulate yourself.
  • Use local support services!

Where can I get help in my local area?

More useful links

Food

Eating a balanced diet and keeping a healthy body weight will help to minimise the risks.

Being over or underweight can increase the risk of issues when having your surgery.

How do I improve my diet?

Many people struggle with having a balanced diet. This might be due to life or work pressure, existing medical conditions, or habits.

Being over or underweight may impair your recovery by increasing your likelihood of complications. If you know your height and weight, then you can calculate your Body Mass Index (BMI) on the NHS website. If your BMI is too high or too low, you can help to change this by making simple changes to your lifestyle such as improving your nutrition and ensuring you get regular exercise. Link to BMI calculator below.

Here are some things you should try to do to achieve a balanced and healthy diet:

  • Eat five or more portions of vegetables/fruit a day. These provide fibre, minerals, and vitamins to help keep you healthy.
  • Eat at least two portions of protein a day. This includes meat, dairy, beans, Quorn and tofu. Protein is needed to help build muscle and heal your body.
  • Eat starchy carbohydrates. This includes potatoes, bread, pasta, rice, and cereals. Carbohydrates provide energy for your body to function. Eating too many carbohydrates can lead to leftover energy turning to fat, leading to weight gain. Carbohydrates are not bad for you. They are important for giving your body energy.
  • Try to avoid processed foods where possible. These foods are not as good for you as the real thing because of the processes they have gone through.
  • Please seek help if you have any problems that cause you a poor intake of food and drink such as swallowing, mouth or teeth problems.
  • Try to limit the fat and sugar you eat – but do not cut them out completely.
  • Have a healthy BMI in the range of 20-25 (kg/m²).
  • It is an old saying but everything in moderation!

Why eat healthily?

There are many reasons to have a healthy diet. The foods you chose to eat can cause or add to medical issues. This could be obesity, high blood pressure and type-2 diabetes. These conditions can cause short and long-term issues for your health before surgery.

Healthy eating is not just about what you eat but it is a large part of it.

Finding the balance takes time when it comes to good eating habits. These habits will help you both physically and mentally. You will have more energy and motivation in the day. It will also improve your wellbeing too.

A well-balanced and healthy diet can be a real benefit when having surgery. A good amount of protein (meat, eggs and fish) can help you heal quicker. Lower levels of salt can help you maintain a healthy heart. These will all help with your healing process.

Top tips for healthy eating

  • Eat regular meals; some people prefer smaller more frequent meals.
  • Avoid sugary drinks and snacks.
  • Eat the right portion size for you – using smaller plates may help with this.
  • Plan your meals to include cooking fresh and healthy foods where possible.
  • Choose nutritious foods that you enjoy.
  • Reduce the amount of alcohol you have, as this can contain lots of calories – and sugar!

Where can I get help in my local area?

More useful links

Exercise

Exercise is key for good physical and mental wellbeing.

Your body has to work hard to recover from surgery. In fact, having surgery has the same effect on your body as exercising; it increases your heart rate and your blood flow. This is your body’s repair process. It needs more oxygen to recover in the early days after surgery. People with higher physical fitness are able to meet this demand more easily. This means their bodies cope better with the stress of surgery.

Video: https://youtu.be/xBLtxMsVWjA

Exercise and your surgery

Improving your fitness, even a little, lowers your risk of complications and can lead to a smoother recovery. Big improvements in your fitness can be made within as little as 2-4 weeks.

The NHS suggests that adults should aim to: 

  • Be active every day. Take the stairs rather than the lift, get off the bus a stop early, or add an extra walk into your day.
  • Build your activity up step by step. Any exercise is better than none. Start slow and build-up over time.
  • Set a goal of working towards doing 150 minutes or more of moderate intensity exercise (e.g. a brisk walk, dancing, gentle swim) a week, or 75 minutes of high intensity activity (e.g. jogging, swimming, cycling) a week – or a blend of the two.
  • Do strengthening activity two days a week (e.g. light weights, resistance body, or using your own body as resistance).
  • Reduce the time you spend sitting or lying down.

Remember to be realistic about your goals, and exercise safely.

Top tips for increasing your activity levels 

  • Drink fluids to keep hydrated during exercise.
  • Focus on the correct technique for each exercise.
  • Set yourself reasonable targets.
  • Aim to exercise for (or build up to) 150 minutes of moderate activity a week.
  • Find someone to exercise with – it’s more fun!
  • Push yourself, but not too much!

Where can I get help in my local area? 

More useful links

 

Alcohol

Alcohol is never good for your health. It can also cause your body to respond badly to surgery.

Reducing how much you drink, or quitting altogether, could make a positive difference to your recovery.

A guide to alcohol units (and signs of alcohol dependence) | NHS

Alcohol and your surgery

The more alcohol you drink, the higher your risk of complications with your surgery.

The UK Government recommends drinking no more than 14 units of alcohol a week.

The NHS recommends spreading these units over 3 days or more and aim for some drink-free days as well.

Regularly drinking more alcohol than this before surgery can lead to longer recovery times, a higher risk of complications, and more.

How much do you drink?

This table shows units of alcohol in alcoholic drinks.

Caption

Type

Units

Single spirit measure (25mls 40%)

1 unit

Alcopop (275mls 5%)

1-1.5 units

Small glass of wine (175mls 12%)

2.1 units

Large glass of wine (250mls 12%)

3 units

Bottle of beer (330mls 5%)

1.7 units

Can of beer (440mls 5%)

2 units

Pint of normal lager/beer/cider (569mls 3.6%)

2 units

Pint of higher strength lager/beer/cider (569mls 5.2%)

3 units

You can also use this  unit calculator  to work out how much you are drinking.

Cutting down before surgery

Cutting down your drinking by any amount will help reduce your risk.

The aim should be to cut down to within 14 units a week.

Ideally, your drinking will have gone down to this level at least 6-8 weeks before your surgery, for the maximum benefit.

Drinking more than 14 units a week may mean you need more checks before your surgery. These will test how well your organs, such as your liver, are functioning.

In the run up to surgery, regularly drinking more than three drinks at a time can:

  • reduce your body’s ability to fight infection.  This can make your hospital stay and recovery longer. Cutting the amount you drink will help reduce the risk. It will improve your chances of a smooth recovery.
  • weaken your heart.  This makes it harder for oxygen to get around your body through the blood stream. Cutting your drinking before surgery can improve your heart’s ability to push oxygen through your body. It improves healing.
  • make it harder for your liver to deal with medication and painkillers used during your surgery.  Cutting down the amount you drink helps your liver handle these drugs better. It gives you a lower chance of side effects like nausea and vomiting.

If you are struggling with your drinking, you can search for services in your local area https://prepwell.co.uk/wp-content/uploads/2021/05/Alcohol.pdf – see ‘where can I get help in my local area’ further down.

Drinking too much alcohol, with or without surgery planned, can cause you harm in the long-term.

If you think you may be alcohol dependent, it can be risky to stop drinking suddenly. You can get advice on how to safely reduce you drinking from your GP or local alcohol service.

Top tips for cutting down on drinking 

  • Set limits before drinking and stick to them
  • Set yourself a budget for alcohol
  • Take it one day at a time
  • Let your friends and family know – they are likely to support you!
  • Drink smaller measures or lower alcohol alternatives
  • Make every other drink a glass of water
  • Try to have alcohol-free days every week
  • Try to reduce your drinking to less than 14 units a week at least 6-8 weeks before your surgery.

Where can I get help in my local area? 

More useful links

Pain management

Good pain management in the time before your surgery is important. It can help you feel ready for your surgery and recover more easily.

Pain management and your surgery

Waiting for surgery or treatment can be stressful and this might have a negative impact on your pain. That’s why it’s useful to manage your pain carefully in the lead up to your surgery. Lots of different things affect pain. These include:

• Problems with your body
• Past experiences and your fears about the pain
• Your stress levels
• Your relationships
• How well you’re sleeping

Taking control of your pain

When people feel in better control of their pain, they do more things that make them feel good. That could be exercise, seeing friends, getting a good night’s rest, or doing hobbies. These kinds of activities put you in a better frame of mind before your operation. There are lots of benefits to managing your pain before surgery.

Getting a better understanding of your pain

Understanding your pain helps you feel more in control. The things we worry about most are the things we don’t really understand. This can bring about anxiety and stress. Science tells us that people who understand their pain better worry about it less and manage it better. Understanding your pain can be useful.

Everything matters when it comes to pain. Making small changes to a few areas can make a big difference. Changing activities for your pain can help you feel like yourself. For example, meet up with friends at home instead of somewhere uncomfortable, or going for a short walk instead of a long one.

Where can I get help in my local area?

More useful links

Diabetes

Waiting for surgery can make lots of things more challenging, including managing health conditions like diabetes.

For example, it can be hard to keep active and eat a healthy diet when you’re waiting for surgery. Related issues such as pain, worry, low mood and being stuck in the house more, can contribute to boredom or comfort eating, which can lead to weight gain.

All of these things can result in higher blood sugar levels.

Unfortunately, uncontrolled diabetes is a common reason that surgeries are delayed or even cancelled.

Am I at risk of developing type 2 diabetes?

You can get help to make positive changes to your diet, weight and physical activity to significantly reduce your risk of developing type 2 diabetes.

Find out if you’re at risk of developing type 2 diabetes by doing any of the following:

  • Answering a few simple questions on the ‘Know Your Risk’ tool at  riskscore.diabetes.org.uk
  • Taking up the offer of a free NHS Health Check to assess your risk of type 2 diabetes, cardiovascular disease and other conditions such as high blood pressure (available for those aged 40-74)
  • Asking your GP Practice to check if you are at risk.

If you are at risk, you may be eligible for referral to the Healthier You NHS Diabetes Prevention Programme by your GP Practice.

Diabetes and your surgery

Having high blood glucose levels can increase the risk of complications during and after surgery, and lead to slower recovery time after an operation.

For this reason, people who have diabetes might have their operation cancelled or delayed* until their glucose levels are within a safer range, which can add weeks or months to the time spent on the waiting list.

Although this can be frustrating, patient safety is always the priority when making these decisions.

* Fitness for surgery is assessed at the Pre-Assessment Clinic appointment.

What are the risks?

People with uncontrolled diabetes tend to have longer hospital stays and poorer outcomes after surgery.

High blood sugar levels contribute to problems like infections, poor wound healing and taking longer to recover.

If you have diabetes, having well-controlled blood sugar levels reduces these risks, and reduces the chances of your surgery being delayed or even cancelled.

The good news is that there’s lots of evidence to show that taking steps to reduce high blood sugar levels improves surgery outcomes and also long-term health.

How can I make sure my diabetes is well controlled?

Know your numbers! 

  • Your HbA1c test result needs to be below 69 for surgery to go ahead.
  • The HbA1c test is a blood test which is done each time you have diabetes review.
  • It gives an indication of what your blood sugar levels have been like over the last 3 months.
  • It should be checked at least once a year.

Ask your diabetes care team if you’re not sure what your most recent HbA1c result was.

Home blood glucose monitoring (fingerprick tests) 

  • If you use a blood glucose meter to test your blood sugar levels at home, the readings should be in the range of 4 to 10mmol/l most of the time, to be safe for surgery to go ahead.
  • Don’t just test your blood sugar first thing in the morning. Blood sugar levels are often at their lowest when people first wake up – but not always! It’s important to test at different times of the day to get an overall picture of your blood sugar levels.

Ask your diabetes care team for advice about how often and when to test your blood sugar levels.

What do you need to do before surgery?

At your diabetes review appointment: 

  • Let your diabetes care team know that you are on the waiting list for surgery so that they can help you to make sure your blood sugar is well controlled.
  • Ask yourself some honest questions before you go to your appointment. For example “Am I eating as well or being as active as I could be?”. If the answer is no, ask for some advice about setting helpful, realistic goals to make positive changes.
  • It can also help to check that you are taking any prescribed diabetes medications at the right time.
  • Ask about Diabetes education programmes in your area, to help you learn more about diabetes and how to manage it.

At your surgery or surgical Pre-Assessment appointments: 

  • Make sure you discuss your diabetes and expected targets for surgery.
  • The surgery team can sometimes refer you to local services to help you manage your diabetes for surgery.
  • They can write to your GP practice or hospital diabetes team and ask them to help you improve your blood sugar levels for surgery.
  • At your pre-assessment appointment before surgery, you will be given advice about how to manage diabetes medications when you come in for your procedure.

Where can I get help in my local area? 

 More useful links 

  •   Diabetes UK website and care line
    There is lots of information about diabetes online. It can be hard to know if the information can be trusted or if it’s safe to follow.
     Diabetes UK is the leading national diabetes charity. There is lots of reliable information about living with and managing diabetes on the  Diabetes UK website .
     Call Diabetes UK on 0345 123 2399 to talk to someone about living with diabetes and get support.
  •   Healthy Living for people with Type 2 diabetes
         NHS England online information and diabetes education for people living with type 2 diabetes in England.
    Find out about how to sign up for Healthy Living:  https://www.healthyliving.nhs.uk/ 

Sleep

Video: https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/how-to-fall-asleep-faster-and-sleep-better/

Plenty of sleep is very important after surgery. This gives your body a chance to recover. It is just as important to get enough sleep before your surgery too.

There are many reasons to try to improve the quality of your sleep before your surgery. When you’re less tired, it’s easier to make better exercise and food choices. Most sleep issues are linked to lifestyle.

Sleep and your surgery

Good quality sleep before and after your surgery is very important. This gives your body the chance to recover from the stress it’s been through.

It’s normal for people to worry before surgery. This can lead to you feeling anxious or stressed. This can lead to disturbed sleep or difficulty sleeping (insomnia).

We understand how important it is to provide the right support for people. We aim to help you maintain a healthy level of sleep leading up to your surgery. This will lead to a speedier recovery and a more positive experience overall.

Importance of sleep

There are four things crucial to being alive- eating, drinking, breathing and sleeping!

We spend around a 1/3 of our lives sleeping. Good quality sleep is important for our bodies to repair and regenerate. A lack of sleep can lead to a range of health issues. This includes, heart disease, high blood pressure and diabetes.

Top tips for better sleep 

  • Stick to a regular sleep routine.
  • Keep good habits and sleep hygiene (see above section).
  • Ensure you have a comfortable bed and a dark, cool, and quiet room to sleep in.
  • Sleep masks and earplugs can help!
  • Try to exercise regularly.
  • Cut down on caffeine, energy, and sugary drinks.
  • Avoid smoking as nicotine is a stimulant.
  • Avoid having too much food and/or alcohol.
  • If things are playing on your mind from the day, try writing them down before getting into bed.
  • Avoid daytime naps.
  • If you can’t sleep, try to do something relaxing until you feel sleepy.

Where can I get help in my local area?

More useful links 

Your GP practice will be able to give you more information to improve your sleep.

In the event that there is a concern for an underlying sleep disorder (Obstructive Sleep Apnoea), you may need further assessment by your GP.

Recreational drugs

Recreational Drug use and your surgery

Marijuana

  • Marijuana use (in any form) and anaesthesia both affect the central nervous system, which means you may need higher doses of anaesthesia medication when you use marijuana for medical or recreational purposes. This can lead to complications like decreased blood pressure and delayed waking from the procedure.
  •   Marijuana use (either inhaled or edible) can increase postoperative pain, leading to higher use of narcotic pain medications and increasing the risk for opioid use disorder after surgery.
  •   Daily to weekly use of inhaled marijuana affects your lungs and increases sputum, coughing, wheezing, and the risk of lung infection. Coughing associated with regular use increases the risk of abdominal and chest incisions coming apart (known as “dehiscence”).
  •   Inhaled marijuana makes your airway more sensitive and can trigger an asthma-like attack when the breathing tube is used during surgery.
  • DO NOT smoke or ingest marijuana the day of your surgery.

Other recreational drugs and their affect on surgery and anaesthesia

  • Stimulants (Amphetamine, Methamphetamine and Cocaine)  Use of these stimulants leads to a variety of problems with surgery and anaesthesia. These substances put you at increased risk of cardiac events during surgery. If you are a long-time user, your anaesthetist or surgeon may need to order an echocardiogram (ultrasound of your heart) to determine if your heart is functioning normally before surgery. They also lead to problems with your lungs during surgery, some of which can be life-threatening.
  • Opioids (Heroin, Methadone, Prescription Opioids)  Injecting these substances makes it difficult to obtain and keep IV access for your procedure, putting you at risk should you need IV medication during an emergency. Use of opioids makes it difficult to control pain after surgery.

**Sharing information with us about your use of recreational substances helps us keep you safe during surgery**.

Do not use any illegal, recreational drugs (including cocaine, marijuana) 24 hours before surgery. If quitting these substances is challenging, you should seek advice from the surgeon and anaesthetist. Let the team know of any excessive use, so plans can be put in place.

Drug addiction: getting help

If you need treatment for drug addiction, you're entitled to NHS care in the same way as anyone else who has a health problem. With the right help and support, it's possible for you to get drug free and stay that way.

Where can I get help in my local area?

More useful links

Reference* Surgical Education — Northern Light Eastern Maine Medical Centre — Northern Light Health