Ask an expert about fitness for surgery 

Dr Robert Stephens fitness for surgery web chat

We know that patients in good health recover better after an operation and have fewer complications. By taking care of yourself beforehand, you can reduce the risk of complications (such as Increased risk of blood clots; lower oxygen levels during surgery; increased risk of wound infection; and increased breathing problems) and help you heal as quickly as possible.

Harms caused by smoking and obesity are potentially preventable and referral to support services prior to surgery offers an opportunity for you to improve your health and reduce the risks of surgical complications. There are other lifestyle behaviours which are good for your health like being active and reducing your alcohol intake.

Our expert is Dr Robert Stephens, consultant anaesthetist whose particular interests include anaesthesia for major surgery, clinical trials, enhanced recovery and the role of the immune system following surgery. He runs the Cardiopulmonary Exercise laboratory at UCLH and is an investigator in two studies examining how to improve the quality of recovery after major surgery.

Dr Stephens was here to answer any questions you had about getting fit for surgery. The conversation covered what you should avoid ahead of surgery and what you should be proactive in doing to optimise your health before an operation.

Below is a transcript of the web chat.

12:38 UCLH: 
Good afternoon and welcome to our web chat. We will begin at 14:00 (2pm), but you can submit your questions now in preparation for the chat. Please note: your questions will not appear in the main chat window until after 14:00 (2pm)

Dr Rob Stephens will be joining us to take your questions on fitness for surgery and will try to answer as many questions as possible within the hour long web chat.
1:59 Dr Rob Stephens: 
Hello everyone
I'm Dr Rob Stephens- an Anaesthetist at UCLH. My interests are fitness before surgery, anaesthesia for major surgery as well as teaching medical students and research- my theses was on the influence of (part of) the immune system on recovery after surgery.
2:00 Dr Rob Stephens: 
It's my first time on a webcast-so i may be slow typing but I'm keen to answer your questions- I can see a few of you have asked already.
2:02 [Comment From Alan: ] 
What are the risks of not being fit for surgery?
2:04 Dr Rob Stephens: 
Hi Alan- you asked me about "What are the risks of not being fit for surgery" I'm imagining you mean what are the consequences or implications for risk of 'not being fit'?

In general - we think that the fitter someone is the less likely they are to suffer complications after major surgery.
2:06 Dr Rob Stephens: 
Now of course- there are a few caveats:
Firstly- this mostly is true for 'major' surgery (although of course all surgery is major for those undergoing it)- by which we mean- when surgery is done to an organ in body cavity - Chest, abdomen (e.g. bowls) or pelvis (e.g. prostate, bladder, uterus) and bid blood vessels.

2:09 Dr Rob Stephens: 
Secondly- the risk we speak of surgery- it is an average- you're more likely to do better the fitter one is. When we study groups of people or patients having surgery, the that can do more exercise, for example are less likely to have to be in hospital for a longer time after their operation.
2:10 Dr Rob Stephens: 
Thirdly- what can patients do about it?- I'l come to that later I suspect answering another question if that's OK, but the summary is we think any increase in exercise whatever you do is probably good.
2:10 [Comment From Theresa: ] 
Hi Dr Stephens, I have type 1 diabetes - would you make any recommendations that are different to someone who does not have diabetes?
2:18 Dr Rob Stephens: 
Hi Theresa- you've asked about an important subject: insulin dependant diabetes. In general the guidelines are the same- for exercise/strength, weight, good general diet, smoking, making sure other illnesses are treated well. For diabetes, we'd like the long term glucose (HbA1c) be as good as possible which reflects sugar control. there will be more details about you as an individual (e.g. what insulin to take and trying to sort your operation early on in the day especially if you can go home that day)
If you google 'recommendations diabetes surgery 2015' one of the guidelines we work is there from our association, 'AAGBI'
2:19 [Comment From Iain: ] 
I am a smoker and I don’t really want to stop smoking. If I stop temporarily for a few weeks / months before the surgery will this make a big difference? I plan to start smoking when I am well again.
2:25 Dr Rob Stephens: 
Ian has asked about smoking. In general, smoking carries short term (more chest infections/pneumonia) risks and longer term ones (more heart disease, strokes etc). The studies have shown a reduction i these short term events (which aren't 'minor' of course- there is about a 20% increase compared to non- smokers. If you are able to not smoke for 2 months before the operation, which may be a tall ask, then your risk of these things (more chest infections/pneumonia) is probably the same as a non- smoker, providing you are otherwise well. I'd also ask about whether the surgery can be carried out awake/sedated (e.g. ankle surgery, hand), but that's not possible in all situations.
2:25 [Comment From L Clarke: ] 
I've had a lot of general anaesthetic as I have had bowel disease and endometriosis. Two years ago I had a hysterectomy and my bowel perforated, it has all but broken me as it left me with an enterocutaneous fistula. I'm due to have surgery for this in the near future but I know I'm not in the right place physically or mentally. I am actually overweight and extremely depressed, it's a low output fistula but nevertheless very distressing. How important do you think a positive mental health is to recovery and how can I get fit when I feel so defeated by what has happened. It was a very unexpected complication and I have found very little support here in west Wales where I live.
2:27 Dr Rob Stephens: 
L Clarke has asked me about her own health, which from her post, has clearly been very difficult and distressing: I'm just writing my post
2:37 Dr Rob Stephens: 
L Clarke: it's hard as it seems you're in a catch 22. I think, first of all i'd try to encourage you to get support - and I hope that's not too trite - for yourself. Whenever i've experienced ill heath (or have had to look after others in my family) i know I couldn't do it alone. Is your GP an option? Family/friends? The hospital where you live may have a stoma nurse to help you with your fistula? It sounds like the first thing would be to try to mentally recover- and that sounds no small thing with what you must have been through. Many hospitals do have fistulae expert surgeons as well with a team. If you're up for it (and all exercise is good) you can exercise at home- even if its gently running on the spot to get short of breath, 3x a week for 5-10 mins then building it up. If that's not even possible- 'even' just upper arm exercises or meditation might help? Do try to get support for yourself perhaps get someone to come to an appointment with you?
2:37 [Comment From Owen Davies: ] 
Enhanced recovery and the perioperative medicine movement is gathering pace in US and UK. What I dont see are many digital solutions to communicate with patients in managing their expectations, share best preoperative routines etc. IS this really the case or am I not looking hard enough?
2:37 [Comment From Owen Davies: ] 
Is enhanced recovery and the perioperative medicine growing in Europe as well?
2:41 Dr Rob Stephens: 
Owen Davies- has asked about the term 'perioperative medicine' and enhanced recovery' - thank you Owen. In terms of digital soutions- there are some apps out there (my UCLH colleagues are using/developing one) I think probably it's a questions of resources - but you're basically right- the solutions are sketchy/ not uniform. BUT there is a growing sense in the UK, USA, Australia and parts of Europe that we can d much better - before, during and after surgery...
2:41 [Comment From Ronald: ] 
In the run up to my surgery, what types of measures should I be looking out for? Blood pressure? BMI? Lung function? What kinds of tests can I do at home?
2:47 Dr Rob Stephens: 
Ronld - partly depends on the type of surgery and what else, if anything, you suffer from. If you have some time (and some would say even a small amount of time would be useful e.g. 2 weeks) it'd be great to increase your physical fitness with exercise (i.e. getting short of breath 3-4 x a week) if it's safe- and it generally is. Many types of surgery are easier to perform if people have a BMI of 20-25, and of course the nearer one is to that the better (i.e. some sensible weight loss is better than none). We have recently relaxed the blood pressure rules- so I'd not necessarily aim very low (less than 160/100 in the community). If you know you might be anaemia (low haemoglobin) it'd be great to get that looked at first.
2:47 [Comment From Elaina: ] 
Looking to the future, wouldn't it be brilliant if my UCLH hospital number produced a fitness programme for me automatically when I book in my operation?
2:52 Dr Rob Stephens: 
Elaina- you're right. I think the problem (and I'm involved in 2 studies on that very subject- as are any others) is that patients have such a lots of information to take i when they are considering surgery. the students we do have say that if all you do is say 'exercise more' or give out a leaflet - maybe as low as 15% of people heed that advice. That said- you can exercise for yourself - anything to get you breathless for 5 mins 3x a week, then slowly increase it. We are looking at a fitness clinic before surgery- but getting people in enough time to make a real difference is hard as, quite rightly, people want to have their surgery in a timely fashion (especially if it's for cancer for example.)
2:52 [Comment From Orla McCourt via Twitter: ] 
Does pre-operative management of elective surgery patients include structured, tailored exercise intervention? This is a key area to utilise AHPs. #AHPsintoAction
2:53 Dr Rob Stephens: 
Orla- via twitter- you're completely correct- and that would be amazing!
2:59 [Comment From Saminder (via email): ] 
Is there any special medication that I should ask my doctor for in the lead up to my operation?
3:03 Dr Rob Stephens: 
Hi Saminder- hard to advise- just with it being a quite general question. If you are well, not on any medicine, having surgery not involving chest/abdomen/pelvis - there's no extra mediciation. For 'major' surgery we may ask you to drink up to 2 hours before, and possibly (there is some evidence) a carbohydrate drink to fool, your body into thinking it's not been starved. You may receive antibiotics, iron if you have anaemia from bleeding, and try to get any other conditions (e.g. asthma, blood pressure, diabetes) under control
3:03 [Comment From Anonymous: ] 
Your biography says that you conducted two studies examining how to improve the quality of recovery after major surgery. What were the results of these studies?
3:08 Dr Rob Stephens: 
Anonymous asked: about studies.There are a few now the 'METS' study (exercise testing before surgery) hasn't been published yet. EuSOS showed a wide variation in care across europe. 'OPTIMISE' Study: the intervention did not reduce a composite outcome of complications and 30-day mortality.
3:12 [Comment From Carol: ] 
I am due to have lower back surgery - decompression of the lower lumbar vertebrae - no exact date. I have difficulty walking but do aqua aerobics 2 X week, What other type of exercise can I do to make me breathless?
3:16 Dr Rob Stephens: 
Hi Carol- It sound like you're doing totally the right thing. If you're up for it- sounds like you are- you can maybe
1) swim alternating with your aqua aerobics?
2) some resistance work- lifting anything with your arms
3) upper arm eg raising your arms in the air?

With the above, take it gently (to make sure you don't hurt your lumbar spine of course) then increase intensity/amount!
3:17 Dr Rob Stephens: 
It's time to end now. It won't be the last time we have a 'fitness' for surgery webcast- I have colleagues (and myself) who would love to do it.
Thank you for smiling in, and all the best with your health.
Dr Rob Stephens

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