Stronger Starts, Better Recoveries: How to Improve Your Surgical Outcomes

No one ever wants surgery, but if you need it, you absolutely want the best possible outcome. In this episode of While You Wait… I share practical, science-backed steps you can take before and after surgery to support your recovery.

From pre-op education and nutrition to exercise, stress management, and even when to sip clear liquids, I cover the details most patients don’t hear until the very last minute. I also opened up about my own breast cancer diagnosis and what preparing for surgery has taught me personally.

Whether you’re facing urogynecologic surgery or any other procedure, these tips can help you feel prepared, confident, and supported through every step of the journey.

Additional Resources:

• YourPelvicFloor.org (IUGA patient resources)
• Pelvic Organ Prolapse Support – peer support community
• AAMC Article on Improving Surgical Results

Timeline:

00:30 Introduction: Preparing for Surgery 

01:32 Personal Story and Podcast Introduction 

02:33 Importance of Preoperative Education 

09:53 Physical Preparation: Exercise and Nutrition 

12:11 Mental and Lifestyle Preparation 

15:08 Day Before and Day of Surgery Tips 

16:53 Post-operative Care and Final Thoughts

Transcript

No one ever really wants to have surgery, but if you're gonna have surgery, you want to have the best outcome that you can. I get a lot of questions about this from my patients, so a lot of women wanna know what they can do to improve the surgical outcome. Okay. Is there a diet you should follow? Should you be exercising?

Should you be exercising before surgery? When can you exercise after surgery? Are there supplements that you can be taking? And this is such a common question that I made a podcast around it so that you would know what you can do to improve your surgical outcome. So this is from a podcast that I did a couple years ago, but the information is still pertinent and it is still helpful to women who are undergoing surgery.

And this is true for Urogynecologic surgery, but it is also true for surgery in general. So listen and learn. Hi there. Today's episode is going to be all about what you can do to improve your surgical outcomes. So I wanted to put this episode together because I was recently diagnosed with breast cancer.

It's very early. It was found on a screening mammogram. My genetic testing is negative. It's categorized as a ultra low risk tumor. But what this means for me is that it's gonna take me away from my clinical practice for a while. And so what this means for me is that I'm not gonna be operating for a period of time.

And then after that I will be operating, but not at the same volume that I normally operate. And so this means that some of my patients will either have to have surgery with my partners or will have to wait. And while this may seem suboptimal. You can use this time to make sure that you are optimized for surgery.

So let's talk about the different things that can improve your surgical outcomes. So the first thing that I wanna talk about is preoperative education. So teaching before the surgery. There are a whole bunch of recent studies that have come out that have shown that preoperative education. Can create better outcomes, that patients recover better, that they're more satisfied with the whole procedure, and that even their postoperative pain is better.

So what that means is that if you understand what you're going to go through, if you understand the surgery, if you understand the steps. Then you often have a better outcome in terms of pain and satisfaction and just ease of recovery. And I think this makes a lot of sense. The problem for me as a clinician is that people want different amounts of information.

So I give everybody the same amount of information, but there are some patients that want surgical videos that really helps them, and then other patients who would never, ever wanna see a surgical video. So there has to be a little bit of give and take here, and you have to ask to make sure that you get the information that you need.

So before a surgery, you should understand the surgery, you should understand what is going to be done. You should understand where your incisions will be if anything is going to be taken out. You should understand this, and this may sound like a very simple thing. When we talk about hysterectomies, a hysterectomy could involve taking out the uterus and the cervix.

You could leave the cervix, you could take out the tubes. You could take out the tubes and ovaries. You could leave the ovaries. And so there are lots of specifics, and so you should understand what organs are going to be taken out, if any. And you should understand what materials are being used. And for my surgeries, this is particularly important.

If we're using a mesh, you should understand what the mesh is made of, and you should have all of your questions about the mesh answered. And if you're not comfortable with the mesh, then we should pick a different surgery. You should also understand the anesthesia. What type of anesthesia are you getting?

Are you getting a general anesthesia? Are you getting an IV general anesthesia, which is more like a twilight and what you get during a colonoscopy. So all of these details should make sense to you. You should understand where the surgery is going to be done. Is it going to be done in a surgery center?

Is it going to be done in the hospital? When I operate in the surgery center, I always tell my patients that it is a very good place to have surgery, but it means that we have no plan B. The plan is for you to go home the same day. And if I operate in the hospital, we do have more of a plan B. You could go home the same day, but you also have the option to stay overnight if you have increased pain or increased nausea.

And so being comfortable with the location of the surgery is also important. I talk to patients a lot about these details. I show diagrams of the anatomy. I show diagrams of the surgery, but sometimes those diagrams don't make a lot of sense to you, and so you may need more. So if you're someone who really wants to investigate the surgery, I would suggest looking at the information that AY UGA provides.

Ay UGA is the International Urogynecology Association and their website is your pelvic floor.org. And there's a list of conditions and surgeries and they go into detail here and there are some diagrams as well. If you're someone who wants videos, there are lots of videos that are available online that are open sourced, and I think in terms of the urogynecology surgical videos I took some time and I looked through some, I don't provide my own surgical videos.

I think Brigham and Women's Hospital, as well as UCLA has put out some really good content. And so if you just Google the name of the surgery, you should be able to find those surgeries on YouTube. But I would tell you to look for ones that come from UCLA or Brigham and Women's. One of the other things that I get asked frequently about surgery, a lot of my patients are looking for a peer who has been through the same surgery.

So a woman who is a couple of steps ahead who's had a similar diagnosis and has gone through the same surgery, and I think that there are a lot of details that such a peer mentor can provide. You know, what did you have at home? What kinds of things were hard for you? Did you have trouble grocery shopping?

I think that there's a lot of reassurance that can be provided here, and Share Home has created a website. And a community that you can join and ask your questions, and it is all women who have had pelvic floor issues who will provide feedback and answer your questions kind of in. Real time. It is a very positive community.

They're very careful to make sure that there aren't any negative comments. There's no selling on this particular website and in this community. And I have had patients who have used this community and gotten the personal answers that they wanted, that they. Either didn't wanna ask me or they didn't feel like I could provide, or, I've never had a urogynecology surgery.

I've only performed them. They wanted that more personal information. So if you feel like that type of support would be helpful for you, or if you would like to have access to that community, maybe in the postoperative surgical period, then I would definitely encourage you to look at that website. And her website is pelvic organ prolapse support.org.

And I'll include all of these links in the show notes. So I, I really cannot emphasize enough how important it is to understand these things before surgery. And I just wanna make one more comment. I think it is really important to understand these things before the day of surgery. Sometimes I have patients ask me really detailed questions right before surgery, and that is a very anxiety filled time, and I'm always happy to answer those questions.

But sometimes it can make you feel very uneasy. You should have all of your questions about the surgery and the details, and taking out your ovaries, using mesh, all of those things. Those should be well established before the day of the surgery. And if that means that we have to go over things a couple of times or you have more questions, that is perfectly fine.

The next thing that you can do to get ready for your surgery is you can actually train for your surgery. So surgery is a trauma to the body and it takes a lot of energy, and patients actually do better if they are in good shape before the surgery. The better the shape that you're in, the better you will do.

And so it has been shown that if you do some aerobic and resistance training, your physical function will improve your body composition, improves your cardio, respiratory fitness improves, and those things can also improve surgical outcomes. So does that mean you need to go crazy? It doesn't. I have had some older, very frail patients and I said to them, you know, I just want you to walk an additional, you know, kind of 10 steps a day, every day before surgery.

I. To build up more of your cardio respiratory fitness for other patients, I will ask them to lift a little bit more or maybe run a little bit more, but this is a time where you want to be doing more exercise and you will find that you will recover much better after surgery. The same thing is true after the surgery.

Patients do better when they are doing some activity, so we want you to be up and walking after the surgery. The other thing that I would tell you is before surgery, it is not a good time to go on a diet. You wanna have good nutrition and optimal nutritional stores before surgery. You need those nutritional stores in order to heal.

Those are kind of the building blocks that allows your body to heal. If you are malnourished during a surgery, people do not heal as well, and there can be more complications in terms of wound healing. You wanna make sure that you're getting enough protein. And so the recommendations are that you're eating two to 2.4 grams per kilogram of body weight.

So if you're someone who doesn't like to eat protein, this is a good time to supplement. You can do nutritional shakes, however you wanna do it. You don't have to eat meat, but you definitely wanna be getting enough protein before surgery. Then the other recommendation is to reduce stress and to encourage wellbeing, right?

So if you're feeling kind of at peace with your decision and at peace with the world, you know, people do much better after surgery. That's a really hard thing to incorporate, I think for a lot of us. But if you're someone who meditates and maybe you're off the practice, it would be a good time for you to reestablish that.

If you're someone who does yoga, this is a good time to get back into your practice. Whatever it takes for you to decrease your stress, it is a good time to be mindful and to address that particular issue. And if you figure out the best way to do it, please let me know because that is something that I struggle with all the time as well.

This is also a good time to cut down on alcohol consumption. So we don't want patients to drink for 48 hours before surgery, but there's also been some studies that have shown that if you can stop drinking at least two weeks before surgery even longer if possible, patients do better. So there's better wound healing, there's less bleeding.

Alcohol can impact the way anesthesia works, so it's good time to address that. It is also a good time to cut down on any recreational drug use, including marijuana, especially the two days before surgery. And if you're unable to do that's definitely something that you want to speak. To your physician about and it's something that you wanna make sure the anesthesiologist knows so that they have all of the information about you.

It is also a good time to stop smoking. Smokers have more surgical complications. They have more problems with wound healing. It affects how your body processes oxygen. And so patients who do not smoke have better surgical outcomes. And so it's a good time to stop smoking. Ideally your BMI would be less than 30, although I know I said it's not a good time to go on a diet.

So those are the big things that you can do before surgery to prepare and to get your body ready for the surgery and to improve your outcomes. If you need more information, it's definitely something that you can reach out to the office, you can use the resources that I provided for you. If you have any questions, you should definitely ask well in advance, and these seem like very simple things, understanding the surgery, eating well, exercising, walking before surgery, not smoking, not drinking alcohol.

They have really been shown to improve the outcomes and so that these are things that you can definitely do to optimize your surgical recovery. I, I just wanna add a, a word about kind of the day before surgery and the day of surgery, since this is really focusing on things that you can do to improve your outcomes.

So we've changed the way we handle eating and drinking before surgery. Right now the most common recommendation is to eat a light meal six hours before surgery and then to have some clear liquids two hours before anesthesia. So clear liquids are black coffee. If you add cream, it's no longer a clear liquid.

Apple juice is okay. Orange juice isn't okay. Water is clearly okay, and the reason that we like people to drink. Before surgery. So those two hours before surgery is that it's actually been shown to decrease nausea and to enhance the return of your bowel function, right? Meaning that you don't get as bloated, your whole gut just works a little bit better.

And so it's important to pay attention to those recommendations before surgery, even if they feel like they are different than you might have seen in the past because they are different. They have been updated recently. I don't usually have patients do a bowel prep. It's incredibly rare. There've been some studies that have shown that bowel preps are uncomfortable and don't really improve outcomes, so I don't do that.

We do frequently give you pain medications before the surgery, so right before the surgery to optimize your pain control after. The surgery we usually, depending on the surgery and where it is, if it's external, if it's not a vaginal surgery, we'll have you wash with chlorhexidine, which just decreases the bacterial content on the skin and that improves outcomes as well.

It's also a good idea for you to know what you might need after surgery, so you will likely need some pads 'cause you'll have a little bit of bleeding or discharge. Having an ice pack to put on the perineum if you're having a vaginal surgery is very nice. I've been recommending to my patients that they use Pips pants after surgery.

So these are a set of shorts that have a special pouch for ice in the crotch of the shorts. And that. Can really help with pain control after surgery. You wanna have MiraLax on hand if you develop constipation after surgery. Sometimes after our surgeries, patients have trouble emptying their bladder and so you wanna understand what might happen with a catheter.

Usually what we will do after surgery, or what I will do is you wake up with a catheter. Once you're able to get up and move around, we fill up the bladder through the catheter, take out that catheter, and make sure that you're emptying at least half of what we put in. And if you are emptying, okay, then you can go home with the catheter.

Sometimes patients do go home with a catheter, which nobody ever likes, and we talk about this a lot. And usually if you go home with a catheter, I will have you take it out the next morning at about eight o'clock, and then if you're having trouble emptying, we'll get you into the clinic by noon and just double check everything.

But I find that you're testing it at home. Actually works better than my testing it in the office. So those are my comments on surgery. I think the other thing about surgery is it's important that you trust the team, that you understand how you would get in touch with the surgeon after surgery. For us, in our office, you just call the office.

There's always somebody on call and the answering service will find that. That particular physician and help you. Most patients don't need that, but you definitely want to know how to activate that service if you need anything or have a question so that you're not waiting. But I think understanding what we're doing, trusting the team, feeling like you're in good hands, all of those things are really important to surgical outcome.

You may want more information for things that you can do to improve your surgical outcomes. I've included an article from the American Academy of Medical Colleges. This is an organization, their goal is to advance medical knowledge and cures patient care and physician workforce development for the health of all.

And this article is all about getting better surgical results, the things that you can do including exercise, food. Breathing and then some mental health exercises that you can do as well as planning ahead. So look for that in the show notes.