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8 steps to recovering from surgery

How you can speed healing and minimize complications

Last updated: April 2013

If you’re scheduled for surgery, your main question is likely to be, “How long before I can get back to my regular life?” As you might expect, the answer depends in part on what type of operation you’re having and how healthy you are going in. But much of it also depends on you.

“People prolong their recovery by not listening to the instructions their doctor gives them, trying to do too much too fast, and not doing wound care at home,” says Jennifer Heisler, R.N., an intensive-care nurse in 
Columbus, Ohio, who maintains the extensive surgery-advice website Surgery.about.com.

The following steps can help you improve your chances of a speedy recovery and reduce the risk of complications that can leave you sidelined longer than you intended.

1. Pick an experienced surgeon and hospital

Be wary of surgeons who are reluctant to discuss their level of experience or are vague about their complication and success rates. Experience is especially important for complex, high-risk procedures such as cancer surgery, coronary artery 
bypass and heart-valve replacement, and abdominal aortic aneurysm repair.

When it comes to picking a hospital, Consumer Reports now rates more than 4,000 hospitals nationwide on measures such as infection and readmission rates, serious complications, and patient experience. We also have a composite safety score for more than 2,000 hospitals. Other sources for information on hospital safety and performance include Hospital Compare.hhs.gov, run by the Centers for Medicare & Medicaid Services.

2. Know what's coming

“I want my patients to have an encyclopedic understanding of what to expect in the surgery and recovery period,” says Patricia L. Turner, M.D., a gastrointestinal surgeon in Chicago and member of the patient education committee of the American College of Surgeons. “For instance, I’ll warn patients that with a laparoscopic inguinal hernia repair, they may be black and blue. It’s not going to hurt much, but it’s going to look horrendous.”

Ask your surgeon what to expect in the immediate postoperative period. Will you be in the intensive-care unit at first? What are the plans for pain relief? What tubes will you be hitched up to?

Also have a discussion about your expectations for recovery. “Speak to your surgeon about what a similar patient having a similar operation experienced,” Turner advises. “A patient with a smoking history, diabetes, and heart disease is going to have a tougher road than a young patient referred by their team coach.”

Finally, discuss your medication. You should stop taking certain drugs and supplements because they can 
affect blood clotting. Diabetics who take insulin may need to adjust their doses.

3. Stay safe in the hospital

Two of the biggest risks of any hospitalization are medical errors and infections. Those are largely out of your control, but you can help mitigate the risk by arranging to have a friend or relative there with you for most if not all of your stay to ask questions, monitor hand-washing and the administration of medication, make sure catheters and IV lines are kept clean and removed when they’re no longer needed (that doesn’t always happen), and speak up in general if something doesn’t seem right. If that’s not possible, consider hiring a private-duty nurse for the job. For more, see our Hospital Survival Guide.

4. Plan your discharge

Jessie Gruman, Ph.D., has had so many life-threatening illnesses and major surgeries that she founded the Center for Advancing Health, a Washington, D.C-based nonprofit organization dedicated to helping patients “find good health care and make the most of it.” But despite her savvy, she was practically pushed out the door of a world-famous hospital after a one-week stay for her most recent operation, which was for stomach cancer.

“I was standing in my underpants untangling my phone charger,” she says, “and a nurse walked in and said, ‘We’ve got your discharge orders. Here’s a prescription for painkillers. Do you want a flu shot?’ That was my discharge plan.”

Needless to say, that’s not how it’s supposed to go. Start asking about discharge plans soon after you’re admitted. Find out whether you will be going home or to a skilled nursing facility. If it’s the former, schedule home care if needed, and nail down plans for physical therapy or other rehabilitation. If you’re going home with equipment, such as drains or wound vacs (vacuum pumps to aid wound healing), make sure you or your caregiver knows how to operate them.

Also be sure to complete “medication reconciliation,” in which you review the drugs you were on before admission and the ones you’ll be taking when you go home to ensure that they’re all necessary and won’t have harmful interactions. And if you have any tests on the day you’re discharged, ask for the results at your first postsurgical appointment, if not before. Those tests often are not followed up.

5. Don't tough out pain

It may set back your recovery, warns Alejandro Gonzalez Della Valle, M.D., an orthopedic surgeon at the Hospital for Special Surgery and an associate professor of orthopedic surgery at Weill Cornell Medical College in New York. After knee replacement, for example, “it is important that patients take the prescribed pain killers,” he says. “Good pain control allows them to rehabilitate faster and develop range of motion.” In contrast, those who are reluctant to take painkillers generally don’t do enough physical therapy, which can lead the knee to heal with thick scar tissue that limits range of motion, Gonzalez Della Valle says.

Taking painkillers if needed can also make it easier to breathe and to cough, which opens your airways and clears out secretions that can increase the risk of pneumonia, according to Mary Ann Bauman, M.D., medical director for women’s health and community relations at Integris Health, a hospital network based in Oklahoma City. If you have an incision in your abdomen or chest, press a pillow over it to protect it while coughing, she suggests.

6. Mind your bladder and bowels

“Slowing of normal bowel activity is common after operations on the GI tract,” Turner says, adding that people who have had large-intestine surgery often have to wait a couple of days for their bowels to start moving again.

There may be something you can do to shorten that period. Chewing sugarless gum reduced the time to flatus (passing gas, an indicator of bowel function) by an average of 14 hours and the time to first bowel movement by 23 hours after intestinal surgery, according to an analysis in the April 2009 International Journal of Surgery.

Even after nongastrointestinal surgery, constipation is common due to the combination of narcotic painkillers, anesthesia, restricted food and drink, and bed rest. Stool softeners, a high-fiber diet (unless your doctor prescribes something else), and plenty of fluids can help get things moving again, as can opting for non-narcotic pain relievers when possible.

As for your bladder, one risk is urinary retention, or the inability to urinate despite having a full bladder, a possible side effect of certain medication. Men with enlarged prostates are especially prone to this problem, which represents an emergency because it can lead to bladder rupture. The treatment is catheterization.

7. Tend to your incision

Common errors include touching the incision with unwashed hands and applying peroxide, lotion, or antibiotic ointment to it. “In the shower, use a regular soap and gently wash it like you would any other body part,” Heisler advises. Don’t bathe or swim until your doctor says it’s OK, because water can soften the skin and cause the incision to pull apart. And don’t pick at the scab.

Check your incision several times a day. If it’s hot or red or seems to be pulling apart, call the surgeon right away.

8. Get moving, but carefully

You’ll probably be made to walk as soon after surgery as possible (it prevents blood clots and helps get your bowels moving again), but ask if there are physical restrictions you need to follow once you go home. Those can vary depending on what type of surgery you had. For instance, “Patients who bend over to tie their shoelaces too soon after a hip replacement will damage muscles, tendons, and ligaments that were carefully repaired and sutured,” Gonzalez Della Valle says. In turn, that damage can lead to pain or dislocation.

People with an incision on their upper body must be careful about lifting and other arm motions that could stress it. Patients recovering from open-heart surgery, for example, have to learn to get out of chairs without using their hands to avoid straining 
the breastbone, which was cut in half during surgery.

Editor's Note: This article first appeared in the monthly newsletter Consumer Reports on Health. 
   

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