One of my jobs as a family doctor is to see my patients before they undergo elective surgery. The purpose behind this checkup is to help ensure the patient will come through it alive and healthy.
A patient of mine recently asked why she had to come in, as it seemed like a waste of time. Not at all. In fact, if you look at one recent study, you’ll see why.
Researchers in Denmark looked at nearly 100,000 people who had their knees or hips replaced, comparing them with similar people the same age who did not. The average age of those having replacement surgery was 65 for hips and 72 for knees. These were not spring chickens.
They found a 25- to 31-fold increase in heart attacks in the first two weeks after surgery. That’s a whopping number. Also, there was no detectable risk for those younger than 60, and super risk for those older than 80.
Other things that played a role here included a previous heart attack, especially within the last six months; coronary artery disease, such has having a stent or plaques in the coronary arteries; congestive heart disease; peripheral vascular disease; diabetes; hypertension; and high cholesterol.
Total knee and hip replacements are among the most common surgeries done today – nearly 2 million worldwide were done last year. They are a boon to anyone older than 50. My wife, Penny, and many of my friends would be disabled today if not for this modern miracle. I say, hip-hip hurray to artificial joints!
But I also say, let’s minimize the risk. Having a heart attack post-surgery is not exactly what you bargained for when you signed the surgical consent form, is it?
My advice is to take that preoperative physical seriously. That means getting full control over any other medical problems you might have, such as blood pressure, diabetes or cholesterol.
Don’t settle for “acceptable” control; have the best numbers possible. That might mean, for example, taking more blood pressure medications or dieting to get your weight down, and getting your blood sugar and cholesterol to more ideal levels.
Next, do whatever exercise you can before surgery to get yourself into better shape. For many with joint problems, this may mean a trip to the pool for water aerobics or time on an exercise bike. If you’re not sure how to proceed, ask your doctor for a referral to a physical therapist.
And while we’re on the topic of surgical complications, I’d like to chime in on something all of you should have on file, especially before a surgery. It’s called a Durable Power of Attorney (POA) for health care or an Advanced Medical Directive. Do you have one?
The POA for health care allows someone to make health-related decisions for you if you cannot. What if you have a post-surgical stroke and end up in a persistent vegetative state, i.e., brain dead? Who do you want to make a decision for you?
Remember the Terri Schiavo case? She had no POA, resulting in a court battle. No one wants that.
With my POA in hand, my wife would be able to make decisions based on my own preferences – and that’s the way it should be. You don’t need a lawyer to create a POA. Your doctor and all hospitals in the U.S. have easy forms to fill out.
My spin: Think of your surgery as your own personal Olympics. Train for it! You cannot reduce your risk to zero, but you can improve your odds of coming out alive and healthy. Stay well.
Dr. Zorba Paster is a family physician, university professor, author and broadcast journalist. He also hosts a popular radio call-in program at 3 p.m. Saturdays on WNED.