Optimizing Surgical Recovery

A 2009 analysis of AHRQ (Agency of Healthcare Research and Quality) delivered a mind-boggling stat. The average American who lives to the age of 85 will undergo 9.2 surgeries within their lifetime. Yikes, I have a lot of catching up to do as does my 81-year-old mother. However, it was an October 26, 2010 Wall Street Journal article entitled “How to Recover (or not) from Surgery” that really made me think about surgery and recovering from it.

I have undergone a few surgical procedures along the way, thankfully planned and not emergency surgeries. The most recent one was in 1989. Apparently, things have changed dramatically in the world of surgery. The article states “Surgery is easier and faster than ever before. Nearly 65% of all surgeries don’t require an overnight hospital stay, compared to 16% in 1980.” Wall Street Journal columnist Laura Landro points out that “reduced hospital time means that patients are assuming more responsibility for their own recover-and more risks.”
That is true, but let’s examine the risks of hospital stays. Medical errors and prescription errors aside, over 2.1 million Americans suffer a “hospital acquired infection each year and up to 104,000 die from these infections.” While a few hospitals are making great strides to reverse the incidence of hospital acquired infections, we have much to do to eliminate this tragedy. Thanks to Harvard’s Lucian Leape, MD, we have begun to acknowledge medical errors in American medicine. However, it appears we have much to do according to the Kaiser Foundation which found 5 years after the 1999 landmark Institute of Medicine’s study on medical errors little had changed to reverse this situation.
There is almost no focus to put into clinical practice practical ways to stress the role of nutrition and lifestyle in recovery from surgery. Most of us would agree that hospitals focus little on eating wholesome foods to aid in surgical recovery. In fact, most of us know a major hospital nearby that serves fast food in the cafeteria and soft drinks to patients. Or, they continue to offer even cardiac surgery patients “mac and cheese” or a “cheeseburger” after surgery. Yes, a major university hospital in the Tampa, FL continues this practice in the year 2010.  Cancer doctors admit they know little and offer little advice even to patients facing a diagnosis of cancer and related surgery.
Renowned cardiologist Stephen Sinatra, MD advises patients “My pre-surgery diet looked very much like my normal healthy diet of lean protein, whole grains, and lots of vegetables and fruit.” Read the research published monthly in the International Journal of Nutrition.  There is much innovation in research to insure the patient has optimal protein to heal (think of protein as the bricks to build a wall in the repair of our organs and tissues), amino acids such as glutamine (our body’s most abundant amino acid), and the good fats such as fish oil and flax seed oil for healing and to modulate inflammation.
The Shriner’s Cincinnati burn hospital has used protein, glutamine, fish oil, and other nutrients to help those with serious burns heal faster and with fewer complications. Swedish Hospital in Seattle used high dose vitamin C intravenously in the emergency room in a clinical study finding faster recovery and less complications. British hospitals routinely use probiotic (friendly flora) supplements to reduce the incidence of antibiotic-resistance and the increased costs of hospital-acquired infections. Talk with innovative plastic surgeons who have long used nutrition and hyperbaric oxygen to help their patients heal faster and with fewer complications. Plastic surgeon Warren Lent, MD states “there are also some nutrients that have been recommended for a speedy recovery after surgery. These include the Omega-3 fatty acids (found in oily fish like tuna, salmon, and mackerel), l-arginine (found in dairy products, meat, poultry, and fish, as well as nuts, rice, whole-wheat, soy, and raisins), l-glutamine (found in meats, fresh fruits, and vegetables), branched chain amino acids (found in meat, whey protein, egg protein, and other dairy products) and nucleotides (found in organ meats such as liver and kidney, legumes, and seafood.) These nutrients can help boost the immune system and allow for a faster recovery. Make sure to get plenty of protein during your recovery as well.”
If that is true for plastic surgery patients, why don’t more surgeons educate and empower patients that nutrition does have a critical role to play in surgical healing and recovery? Those trays of lime Jell-O, bouillon broth, sherbet, and ginger ale should be a thing of the past. A 2009 University of Toronto study found that consuming food before surgery (in the form of a carbohydrate rich drink) improved insulin resistance after heart surgery. And, a 2008 study from the Archives of Surgery found chewing gum assists the recovery of intestinal function following surgery. Too few surgical patients are armed with this information.
The take home message is clear: “We are going to be more and more on-our-own after surgery. Let’s educate ourselves and make wise lifestyle choices before and after surgery to speed our recovery and reduce complications. The science is sound about the clinical use of nutrition. You would not tell your child to eat fast food and drink soda after surgery. Educate yourself and be a mentor to your family. Nutrition does matter.”
Deborah Ray, M.T. (ASCP)