Do this before surgery for a better outcome

You know about rehabilitation, using physical activity, nutrition and emotional support to help you recover after surgery.

But what about prehabilitation – using those same tools to get you in shape before surgery?

“Rehab, even before surgery, is important,” said Jonathan Sunkin, MD, an orthopedic surgeon at Falmouth Orthopedic Center and Falmouth Hospital. “I’ll tell people, the stronger you are going into surgery, the stronger you are coming out.”

A recent University of Ottawa study that reviewed data from more than 15,000 patients considered if exercise, nutritional enhancement (specifically a high-protein diet) and cognitive and/or emotional support before surgery made a difference in recovery. The study included all kinds of surgical patients, not just those undergoing orthopedic procedures. Exercise and nutrition were found to be particularly helpful, according to researchers.

That fits with what Dr. Sunkin, who specializes in joint replacements, sees in his practice. In prehabilitation, patients can gain mobility and strength after a joint breakdown or injury, such as an arthritic hip or torn ACL (anterior cruciate ligament), before they face surgery. That’s important because surgery is actually another injury to the same area, he said.

“After an ACL tear, for example, it’s an injury. Your knee is painful. It’s swollen. It’s stiff. And so, we do send people to physical therapy for a month to recover from their injury, to get that motion back, let the swelling go down, to get that muscle nice and strong again.

“We try to let people recover from their injury before we talk about surgery.”

Protein and Other Considerations

Nutrition can also make a difference, he said, particularly for older patients, who may be malnourished or have difficulty absorbing nutrients. Protein has been shown to build muscle and promote healing. It’s also associated with the ability to fight infection. “So, if someone’s protein is low, I would worry about tissue healing and potential infection,” he said.

One way doctors measure nutrition is by the level of a protein called albumin in a patient’s blood. If it’s low, then a patient might want to consider supplementing their diet with more lean meats or perhaps protein supplements, Dr. Sunkin said.

There is another category of prehab that can help pre-surgical patients, Dr. Sunkin said. That’s “medical optimization” and includes giving up tobacco, losing weight, and getting blood sugar levels under control. For example, quitting smoking two months before surgery can significantly lower the risk of complications like poor wound healing, according to the National Institutes of Health.

“Those are all what we would consider modifiable risk factors that are associated with a poorer outcome after surgery,” Dr. Sunkin said. “So, if we can take care of anything on the front end, I think it really does make recovery easier after surgery.”

Mental Health and After Care

It’s also important to take care of your mental health and plan for after-care and support, he said. If patients are going home, they need to prepare their space, perhaps rearranging a bathroom, and how they will get support, he said. They even need to have a plan for pets.

“Surgery is stressful,” Dr. Sunkin said. “I want patients in the best mindset that they can be going into surgery. People will have pain after surgery. Potentially they’ll have limited mobility after surgery. And just having a support system in advance will make it better on the back-end.”

There are many things orthopedic experts still don’t know about post-surgical healing, Dr. Sunkin said. For example, is there a specific diet that makes a difference? "But based on the research it seems to help to do some kind of physical and mental preparation – and have a plan."

“I spent some time in the Air Force during my medical training, and there was a saying that if you fail to plan, you plan to fail,” he said. “The whole prehabilitation part reminds me a lot of that. We have this opportunity when we're talking about elective surgery to just do everything we can to try to ensure people have the easiest, most rapid recovery, or opportunity to recover.”