A Global Pandemic, Delayed Surgery, and You

By Mario Leyba, MD, and Brand Newland, PharmD

Thousands of surgeries have been postponed since the beginning of the Covid-19 pandemic. As compared to 2019, knee replacements are down 68%, hip replacements are down 52% and cancer surgeries are down 18%. As a patient forced to change plans, you are not alone.

This can be frustrating and adds to the anxiety of these uncertain times. However, healthcare providers have already begun re-scheduling “elective” surgical procedures in some areas. Now is the time to begin preparing for a successful (albeit re-scheduled) surgery and recovery.

Here’s what you should know:

  1. An Ounce of Prevention is Worth a Pound of Cure

Going into surgery as healthy as possible is among the most important things you can do to prepare for successful recovery and getting back to life.

A few extra weeks could be just the time you need to get yourself in the best place possible for surgery. And doing so may just not only improve your experience but also help your case to be prioritized when surgeries begin again. After all, healthcare providers will be looking to schedule procedures that are either (#1) most urgent or (#2) least likely to require hospital resources that might take resources away from pandemic efforts.

If you are prepared for surgery, you are less likely to experience complications and lengthy hospitals stays and, thus, you fit squarely in category #2.

Some suggestions:

  • Optimize nutrition

Protein, plant-based foods and fiber prepare your body for healing and a faster return to normal life after surgery.

  • Exercise

Improving your muscle strength and cardiovascular fitness provides a great baseline for the post-surgery recovery by improving blood flow to speed healing. There are many resources available online for selecting the right exercise for you. For example, the Arthritis Foundation provides one geared toward pre-surgery preparation.

  • Stop smoking

We know you’ve heard it before but there might not be a more important time to quit smoking than in the time leading up to surgery. Even just a few weeks tobacco-free before surgery shortens recovery, improves healing and reduces risks. Optimally, you go into surgery tobacco-free for at least 1 month and stay tobacco-free for at least 1 month after surgery. If you do this…keep going! There are many resources to quit smoking. Here is one great resource from Mayo Clinic.

The American College of Surgeons provides additional useful information about surgery preparation through its “Strong for Surgery” program.

  1. Listen to Your Body and Communicate

If the symptoms that led to your need for surgery (e.g., pain) worsen or new symptoms appear, contact your surgeon’s office. The doctor may want to speak with you more about these changes, possibly with the help of telehealth technology. And it’s possible the changes mean your surgery is becoming more urgent.

  1. Use Non-Prescription Pain Medications Confidently

Leading up to surgery, many patients experience pain requiring treatment with non-prescription, over-the-counter pain medications. These medications (e.g., acetaminophen, ibuprofen, naproxen, and others) can be highly effective for pain, both before and after surgery.

It is important for patients to understand the differences between the medications so you can get the most benefit from their use and so you can feel confident you aren’t causing more harm than good. Here’s a summary:

Medication Name Acetaminophen
Brand Name Tylenol
Dose per Pill 325mg
Dose/Frequency 1-2 pills every 4-6 hours
Daily Limit Do not take more than 12 pills in 24 hours
Concern when over limit Liver

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Medication Name Ibuprofen
Brand Name Motrin
Dose per Pill 200mg
Dose/Frequency 1-2 pills every 4-6 hours
Daily Limit Do not take more than 6 pills in 24 hours or for more than 1 week straight
Concern when over limit Stomach, Heart, Kidneys

 

Medication Name Naproxen
Brand Name Aleve
Dose per Pill 220mg
Dose/Frequency 1 pill every 8-12 hours
Daily Limit Do not take more than 2 pills in 24 hours
Concern when over limit Stomach, Heart, Kidneys

One final note:  acetaminophen and an NSAID (ibuprofen or naproxen) can be used at the same time for additive pain relief. In fact, this combination can be so effective it may be the exact regimen your physician will recommend after surgery to reduce your need for other pain medications, such as opioids.

  1. Ask Your Doctor about Enhanced Recovery Protocols

Surgery guided by Enhanced Recovery has been shown to reduce time in the hospital by 30%, complications by 50% and overall recovery time by weeks. This 21st Century surgery remains difficult to find on your own, however. Ask about it. Then ask again. You may even want to use this list of questions as a guide for your conversation.

The benefits are meaningful to getting back to work and life—not to mention avoiding opioid painkillers—in normal times.

During a pandemic, the benefit of minimizing exposure to healthcare settings couldn’t be more important. Less time in the hospital, emergency room and clinic means fewer chances to be exposed to Covid-19 positive patients.

  1. Covid-19 Testing

Most hospitals have a plan for resuming elective surgeries and many involve Covid-19 testing. Ask your provider what the hospital or surgery center requires. Most of the time, this can be scheduled for you. Most importantly, if you develop any Covid-19 symptoms, seek medical attention immediately and inform your surgeon. Stay safe, stay healthy, and stay informed!

 

One day, hopefully in the not-too-distant future, we will find our way to the other side of the pandemic. Surgery and the rest of life will return to “normal.” Until then, you can control what you can control—your preparation for surgery and the questions you ask. Don’t miss the opportunity to do so.

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