American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

About Strong for Surgery

Strong for Surgery is helping to improve clinical outcomes.

A patient’s risk of negative outcomes from an operation can be improved by using best practices in the preparation for surgery. We've searched the globe to bring effective methods into checklists and ensure patients are optimally prepared for their upcoming operation.

Strong for Surgery brings a presurgery checklist to surgeons' offices to help with education, communication, and standardization of best practices to improve clinical outcomes.

Introduction to Strong for Surgery from Dr. Varghese

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Overview of Strong for Surgery

Strong for Surgery is a public health campaign that engages patients and their surgeons to improve overall health and increase the likelihood of a positive surgical outcome. Preoperative checklists serve as a communication tool for patients and clinicians to consider four common risk areas. 

Nutrition

Nutritional status is an important independent predictor of surgical outcomes. Factors such as unintentional weight loss, changes in dietary intake, and gastrointestinal distress indicate that a patient may be at risk and should be referred for nutritional counseling. Use of a specialized nutrition formula to address immune suppression can reduce infectious complications by 40 to 60 percent.

Smoking Cessation

Smoking correlates with 40 percent higher prevalence of postoperative complications and is an independent risk factor for infections and cardiovascular events after an operation. Smokers who undergo spine surgery have a two to three times higher rate of non-union for spine fusion, are less likely to return to work after surgery, and have more pain and lower satisfaction with their recovery. To improve outcomes in patients currently smoking, providers will advise patients to stop smoking and choose a quit date, and refer them to available resources.

Glycemic Control

Proper blood glucose control in diabetic patients having surgery can help support healing and lower the length of stay. Establishing control of blood glucose prior to surgery reduces the chance of hyperglycemia and hypoglycemia during the perioperative period. Studies have shown hyperglycemia can double the risk of surgical site infections. Checking blood glucose prior to an operation is a way to identify patients with undiagnosed diabetes, a reported one-third of all patients having operations, and let clinicians start treatment before hospitalization.

Medication Use

A thorough review of all medications including over-the-counter drugs, supplements, and herbal remedies is important so that the patient can be advised accordingly. Evidence shows that aspirin and beta blockers can be safely continued throughout the perioperative period for cardiac protection with most operations. Some medications, however, increase bleeding risks and should be stopped before an operation. Specific herbal medications, including echinacea, garlic, gingko, ginseng, kava, saw palmetto, St. John’s wort, valerian, can also increase risks.

Delirium

The recognition and treatment of delirium is critically important because postoperative delirium is associated with poor outcomes including functional decline, longer hospitalization, institutionalization, greater costs, and higher mortality. Studies have shown that age, alcohol abuse, poor cognitive and physical functioning, and abnormal laboratory values have been associated with delirium. High-risk patients identified for exhibiting some of the risk criteria can be candidates for interventions designed to prevent or reduce the impact of postoperative delirium.

Prehabilitation

Cognitive, gait, balance, and nutritional and functional impairments place patients at higher risk of perioperative and postoperative complications. Prehabilitation is an opportunity to help patients return quickly to the highest level of functioning possible after their operations, thereby reducing surgery‐related morbidity and/or mortality, decreasing the length of stay in hospital and rehabilitation, and reducing readmissions.

Safe and Effective Pain Control

Unrelieved pain can result in longer hospital stays, increased rate of readmission, increased outpatient visits, and decreased ability to function fully. To ensure safe, effective pain management after operations, it is recommended that patients receive counseling prior to their procedures. Presurgery counseling with patients that involves expectation setting, potential adverse effects, and the use of non-prescribed medication for pain relief can help patients set realistic goals for recovery.

Patient Directives

An important aspect of patient safety is patient education. Patient education before surgery helps minimize presurgery anxiety related to the operation itself. During this time, discussion referencing the financial burden, postprocedure pain, surgical risks and the necessity of the operation are also important. The patient should feel supported in the preoperative period and should be encouraged to express his or her feelings about the surgical experience.