The Power of Surgery Preparation

Professor Scarlett McNally, Consultant Orthopaedic Surgeon and the Deputy Director of the Centre for Perioperative Care has advice on getting in shape for surgery and how to get the best outcome.

Bethan Cole

Preparing for Surgery – What Can Go Wrong

“It’s not like getting guttering fixed!” jokes Professor Scarlett McNally of having an operation scheduled. “You trust the system, maybe you’ve got your leg in plaster, but you’re surrounded by amazing people and you know you’ll be looked after and that NHS staff will do their best.” The problem is that it’s not always like this and a considerable percentage of operations - 10-15% - have a complication, according to Professor Scarlett.
At the Centre for Perioperative Care (where Professor Scarlett is Deputy Director) they’re trying to improve everything for the patient – from the moment an operation is considered until full recovery. “Over 10% of our population is on an NHS waiting list for something,” she continues. Which is obviously not good news.

Importance of Fitness Before Surgery

But there is hope. Professor Scarlett says that “People who prepare for operations reduce their risk of complications by 30-80%.” Preparing before an operation will also reduce the length of stay in hospital by one day. “A lot of people could have their operation as a day case if they prepared properly and we save beds that way.”

One of the major ways to prepare, explains Professor Scarlett, is to stop smoking. But another major way to promote optimal surgical recovery is exercise. “There is a lot of evidence that it reduces complications and reduces the length of stay in hospital,” affirms Professor Scarlett, “people who are physically inactive have a 4 x greater risk of complications. Studies show that exercise halves complications.” 25% of the population of the UK are classified as physically inactive. “As a surgeon you can just look at someone and know their chance of a problem is higher,” she confirms. The long waiting list should allow time for people to get fitter in readiness for an operation. What’s more 45% of operations that require anaesthetic are people over the age of 65. “We need to get that cohort fitter,” adds Professor Scarlett.

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How Does Fitness (for Better Surgery Results) Help?

Professor Scarlett lists many ways

The heart and lungs are fitter for anaesthetic.
Exercise has a positive effect on inflammation.
Exercise reduces the chance of cancer coming back.
It helps with metabolism because your sugar levels are not up and down – particularly important for people with diabetes.
It is empowering for patients, people feel they are doing something.
It reduces the need for strong painkillers (you can manage pain better if you do exercise because the body makes endorphins which are the body’s natural opiates)
If, from exercising, you’re carrying muscle rather than fat, it is a source of protein and the body recycles this protein, after an operation, to heal and produce scar tissue and antibodies.

Surgical Fitness Tips

The main thing is to get started and then to carry on. “People think you need an exercise programme with a coach or personal trainer. But you don’t,” says Professor Scarlett. “Just get started and do something, that’s better than doing nothing. There is more evidence that getting started has the biggest impact. Just doing a bit, 1 x per week or 5 mins per day has a huge positive benefit. Macmillan the cancer charity found that just 3 x per week training for cancer surgery produced really good results.”

What’s recommended to prepare for surgery is 150 minutes of moderate intensity exercise per week.
Swimming is a good form of exercise if you’re obese, have leg problems or back problems.
Jogging and cycling are also good. Choose what you do and get it done.
It’s important to build strength in the legs. Try sitting to standing without using your arms. Do it for 1 minute. This is good for the thighs.
Balance is also important. For this try yoga or pilates. Even just standing on one leg whilst the kettle boils or you are brushing your teeth. (Women age 65 plus have a 1 in 4 chance of breaking their hip. The largest use of NHS beds is for hip fractures.)
Deep breathing exercises are also helpful. You are less likely to get a chest infection and more likely to be able to cough things up if your breathing is improved.
Walking up and down stairs is also good surgery preparation.

Professor Scarlett’s own Pre and Post Surgery Routines

Professor Scarlett practises what she preaches and is a very inspiring case study herself. During the last 10 years she’s had a hip replacement and been through myeloma – a type of cancer of cells in the bone marrow with cardiac amyloidosis which damages the heart.

“I had a hip replacement so I had to learn to balance on my other leg. I was experiencing a lot of pain in my hip which is a ball and socket joint. While I was waiting for the operation I had problems sleeping. I would wake up at night turning over and it was very painful. I was using a walking stick. I knew I had to get fit.

So I went out on my electric bike every day – in all weathers. Up to 1 hour a day gives benefits. Most days I did 1 hour a day of cycling, around 7 miles. I could cycle but not walk.” Her friend, a physio, taught her how to balance on her other leg and do things like plug in her phone charger to be ready for after the operation. “I didn’t need the ongoing painkillers, the arthritis pain had gone,” she remembers. “The key is to find something where it doesn’t hurt too much. I bought a static exercise bike for after the operation too.”

With the cancer she also exercised to prepare for surgery. “I couldn’t walk up the stairs, my heart was rigid. I got short of breath walking up the stairs.” She was having chemo but it wasn’t working well. The best option was a stem cell transplant. “I wasn’t eligible for this cure though because my heart was so bad.” And so she got on her electric bike and got fit. “I knew I had to get fitter to get the stem cell transplant. I believe I would be dead by now if I hadn’t had the electric bike,” a dramatic statement, but not one a medical Professor and Consultant Surgeon would make lightly. Hers is an inspiring story.