Preop Rx Simplify your surgical journey, improve your surgical outcomes
“how to have surgery, safer”
TABLE OF CONTENTS 01
SURGICAL RISK FIXED AND MODIFIABLE RISK FACTORS FOR SURGICAL COMPLICATIONS
02
RISK MITIGATION
03
PREHAB EXERCISES
NUTRITION, PROTEIN, VITAMIN D, MRSA & BACTERIAL DECOLONIZATION, POSTOP PAIN CONTROL & OPIOIDS, DELIRIUM PREVENTION
LUNG, HEAD, (JOINT)
TIMELINE (days before surgery)
04 05
-7 DAYS, -5 DAYS, -2 DAYS BEFORE SURGERY & THE NIGHT BEFORE SURGERY
LISTS HOUSEHOLD READINESS ADVANCE DIRECTIVES & HCPOA FORMS PREOP APPOINTMENT OVERNIGHT AT THE HOSPITAL CHECKLIST (if you are staying overnight)
1
C H A P T E R
SURGICAL RISK R E D U C E S U R G I C A L C O M P L I C A T I O N S
WHAT IS SURGICAL RISK? A complication after surgery infection blood clot pneumonia heart attack or stroke longer hospital stay or hospital readmission Worsening of your overall health after surgery Death after surgery
There are FIXED & MODIFIABLE RISK FACTORS for surgical complications FIXED RISK FACTORS Fixed RISK FACTORS include sex, age & genetics.
MODIFIABLE RISK FACTORS Modifiable RISK FACTORS include smoking, blood sugar, nutrition, bacterial colonization, poor physical conditioning, obesity, sleep apnea and frailty. You can do something about these risk factors.
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C H A P T E R
SURGICAL RISK MITIGATION R E D U C E S U R G I C A L C O M P L I C A T I O N S
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SURGICAL RISK MITIGATION you can impact your surgical outcome 1. Nutrition, protein and Vitamin D 2. Bacterial decolonization & MRSA 3. Lung Prehab 4. Head Prehab 5. (Joint Prehab) 6. Opioid use, storage and disposal 7. Delirium prevention
Focus on Nutrition: Protein/Vitamin D Supplementation
& Bacterial Decolonization
PRESURGICAL NUTRITION: more than eating lots of fruits & vegetables
Bones are ~40% protein. You need a lot of protein to heal well! How much protein do you need per day? Eat 1.5-2 grams of protein per kg of body weight per day 5 days before & 5 days after surgery Weigh 150 pounds? You are about 70 kg. You need:
100-140 grams of high quality protein per day And that my friend, is a lot of protein!
Good sources of high quality PROTEIN
Examples of commercial high protein products (in case you want to supplement)
Vitamin D is a known immunomodulator Get your Vitamin D Level Checked! Supplement if necessary
Goal: at least 30 ng/ml
BACTERIAL DECOLONIZATION PREOPERATIVE SKIN PREPARATION reduces skin bacteria which reduces surgical site infections Surgical site infections (SSIs) Add 7 to 11 days to your length of stay Increase costs by an average of $25,546 Patients who develop an SSI are also “twice as likely to die” Find a detailed explanation of how to reduce skin bacteria on the link below https://www.youtube.com/watch?v=s2xGNkIt9ZA
BACTERIAL DECOLONIZATION or simply institute
STRYKER NOSE TO TOES
MRSA: ask to be tested or treat empirically (prescription required)
Mupirocin twice a day 5 days before surgery
Wash hands with soap & water Apply a pea sized dose to each nostril Press the sides of the nose together and gently massage the nose for 60 seconds Change into freshly laundered PJs and pillowcases each night after mupirocin treatment
OPIOIDS Opioids treat moderate to severe pain AND use may lead to dependence, addiction, even death One year after surgery, about 1 in 10 surgical patients will be using opioids Protect yourself, your loved ones, pets, & visitors from harm
Store opioids in a safe and secure place Your bathroom, or kitchen cabinet or your night stand are not secure. LOCK AND HIDE ALL OPIOIDS
Who is at risk for opioid abuse? Everyone is at some risk for opioid dependence after surgery (low, medium or high risk)
Curious? Click on the link below
PHOTO WITH TEXT TITLE
Opioid Disposal When opioids are no longer needed, dispose of properly
Use the link below to find out where you can easily & safely drop off your extra pills
DROP OFF YOUR OPIOIDS HERE
Delirium If you are 65 years or older, or have preexisting cognitive dysfunction or are “frail,” you are at risk for delirium after surgery If possible, have a loved one or friend stay with you overnight during your hospitalization
Check out UCSF’s suggestions on how to prevent delirium after surgery
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C H A P T E R
PREHAB EXERCISES R E D U C E S U R G I C A L C O M P L I C A T I O N S
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Lung Prehab Incentive spirometer, repeat 10 times, 4 times a day https://m.youtube.com/watch?v=-OZawtb32o
Blow up a small balloon in 1 breath, hold for >5 seconds repeat 10 times, 4 times a day l
Why bother with Lung Prehab? A better question is, why not? Lung Prehab may: decrease the work of breathing increase alveolar inflation improve oxygenation, ventilation reverse hypoxia
Lung Prehab Tools Will lung prehab prevent pneumonia? It sure won't hurt...
Head Prehab *"N E R VOUS? W E C ALL THAT N O R M A L ! W E T AKE AWAY Y O U R U N D E RP A N T S & P U T YOU IN A R O O M F U L L O F S T R ANGERS" Cut down on alcohol in the weeks leading up to surgery Take this quick depression screen. If you might be depressed, talk to your family doctor before surgery https://whooleyquestions.ucsf.edu Practice relaxation techniques https://www.nhsinform.scot/healthyliving/mental-wellbeing/stress/ breathing-and-relaxation -exercises-for-stress
*What I tell every nervous patient I meet in preop
Joint Prehab
THUMB BASILAR (CMC) JOINT ARTHROPLASTY 01/09/2023 WEEK OF DECEMBER 23RD 2 WEEKS BEFORE SURGERY PURCHASE PROTEIN SUPPLEMENT, INCENTIVE SPIROMETER START LUNG, HEAD PREHAB
THURSDAY JANUARY 3 10 AM JAMIE, PA 1 PM PREOP CLINIC
WEDNESDAY JANUARY 2 7 DAYS BEFORE SURGERY START PROTEIN SUPPLEMENTATION 100 -150 GRAMS
WEDNESDAY JANUARY 4 5 DAYS BEFORE SURGERY START NASAL MUPIROCIN 2 X PER DAY UNTIL MORNING. OF SURGERY FRESH PJS AND PILLOWCASES EVERY NIGHT
SATURDAY JANUARY 7 CHLORHEXIDINE BODY WASH TONIGHT & TMRW, THE NIGHT BEFORE SURGERY SUNDAY JANUARY 8 DAY BEFORE SURGERY NO EATING AFTER MIDNIGHT
MONDAY JANUARY 9 DAY OF SURGERY DON'T EAT, OK TO DRINK "CLEARS" UP UNTIL 2 HOURS BEFORE YOUR SCHEDULED TIME OF HOSPITAL ARRIVAL
OLIVIA WILSON
W O R KBOOK
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C H A P T E R
RESOURCES, TO DO & LISTS R E D U C E S U R G I C A L C O M P L I C A T I O N S
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Advance Directions & Health Care Power of Attorney https://www.sosnc.gov/documents/forms/a dvance_healthcare_directives/Brochure.pdf
https://www.sosnc.gov/documents/forms/advance_ healthcare_directives/health_care_power_of_attorney.pdf
IF YOUR ADVANCE DIRECTIVES &/OR HEALTHCARE POWER OF ATTORNEY ARE NOT UP TO DATE, YOU MAY GET THEM WITNESSED AND NOTARIZED AT THE HOSPITAL
Your surgeon & anesthesiologist needs all of your medical records. Bring these records to your PREOP appointment Heart Doctor/Cardiologist info most recent cardiology office visit note most recent EKG most recent echocardiogram most recent cardiac catheretization
Lung/Pulmonary info most recent office visit note most recent PFT results
Don't eat after midnight on the day of surgery! Why? Click the video below.
Day of Surgery List Do not eat or smoke after midnight - your surgery will be cancelled if you eat. Why? Under anesthesia, you may vomit up your stomach contents and this mess goes into your lungs—> pneumonia! death! yikes! Wear loose fitting clothes Don't bring valuables with you to the hospital, including credit cards Bring insurance cards & a photo ID Do not wear contact lenses If you wear glasses bring a case to store them in Bring reading materials or music to help pass the time You may not taxi/Uber/Lyft home unless accompanied by an adult You will need an adult (aged 18+) to be immediately available & reachable by phone
Overnight Hospital List Cell Phone Charger with long cable Earbuds or head phones (noise-canceling headphones are ideal) Smartphone, tablet and or laptop Reading material Shoes or slippers Sweater or vest: Hospitals are cold! Ask for more blankets if you need them. Underwear, change of clothes for trip home Dry Shampoo, comb/brush Sleeping Mask, ear plugs, your own pillow or pillowcase Notebook & Pen/Pencils Lotion Chapstick Toothbrush, toothpaste, floss Hand sanitizer Antimicrobial wipes Non-Perishable Snacks
Preop Holding (if staying overnight) Before surgery, you will be in a small, curtained room. Your surgeon will see you prior to going to the OR. Ask your surgeon, resident or PA to place the following “standing orders” Postop pain control, acetaminophen 975 or 1000 mg every 8 hours round the clock (this is key)! Ask for daily Colace or MiraLax (or drink prune juice with meals) Incentive Spirometer at the bedside Sleep medication, if you must use it to get a good night’s sleep
Menu Maintain a high protein diet and include these daily menu items: Include a high protein drink (Ensure/Boost) with every meal Include high protein jello with every meal or for snacks Include daily prune juice to keep your bowels regular
How to use Tylenol/acetaminophen for pain control People often say that Tylenol does not work for them. The correct dose and the correct frequency are key to getting good pain relief
1000 mg Tylenol every eight hours Ice packs 10%
Meloxicam 20% Tylenol 50%
Opioid 20%