Preparing for surgery

We aim to provide the best possible care to all of our patients undergoing surgery or procedures. We hope to help our patients make the best choices to get fit for surgery and recover faster. To help us achieve this and to have a meaningful benefit, work needs to start ahead of admission to hospital.

There are five areas that are important in successfully recovering from a procedure: stopping smoking, undertaking physical activity, achieving a healthy body weight, reducing alcohol consumption and managing ongoing medical problems.

We hope you can use the resources provided to give you the best chance of successful surgery and a quick recovery. Our aim is to get you back home fitter and faster, but we can’t do this without your help.

Some patients are also referred to our dedicated Prehabilitation Service for people living with cancer and due to undergo surgery as part of their treatment. The service offers a holistic approach to your health and wellbeing and can inspire you to adopt healthy lifestyle behaviours.

Cancer pathway patients may want to access the Nottingham Macmillan Information and Support Service based at Nottingham City Hospital and Queens Medical Centre. The service provides a free and confidential drop-in service for anyone affected by cancer. Macmillan Information and Support Service | NUH

You may also want to access a useful leaflet and video produced by The Royal College of Anaesthetists to help patients prepare for their surgery.

Preparing for surgery – Fitter Better Sooner | The Royal College of Anaesthetists (rcoa.ac.uk)

Stopping Smoking

It is important to stop smoking completely before your operation. There is very strong evidence that demonstrates length of stay and complications are worse in those who smoke¹. To get the greatest benefit from stopping smoking, this should occur at least four weeks prior to surgery².

The best way of stopping smoking is with a combination of medication and specialist support. You are three times more likely to stay quit with this combination. Your Pre-op Assessment Nurse can refer you to stop smoking services and commence nicotine replacement patches. You can also speak to your local pharmacist.

Nicotine is the least harmful component of a cigarette (apart from being highly addictive). When a cigarette is lit it is the tar, carbon monoxide and thousands of other chemicals that are toxic. Nicotine replacement therapy gives you clean nicotine in order to help with withdrawal symptoms, it is important to use it regularly. Vapes contain only a fraction of the chemicals found in tobacco and is allowed in the hospital grounds (not inside the buildings).

You can get help by visiting:

Nottingham City Residents - Stub it! - Nottingham City GP Alliance (ncgpa.org.uk)
Nottinghamshire County Residents - Stop Smoking - Your Health Nottinghamshire (yourhealthnotts.co.uk)
Countrywide - Quit smoking - Better Health - NHS (www.nhs.uk)

Undertaking physical activity

Exercising regularly develops your physical fitness, which is important in ensuring you are able to tolerate the stresses imposed by surgery. Exercise should be completed at a moderate intensity, which should raise your heart rate and leave you slightly short of breath, but still able to hold a conversation. Government guidance suggests this take place for 30 minutes, 5 days per week. This could include walking quicker than your normal pace, going to a gym or swimming pool, or even a chair based exercise programme. It is important you find a programme that is suitable for you and your health needs. Recovering from surgery is quicker and easier if you have prepared your body prior to having the procedure.

It is important to find a way of exercising that works for you. If you find something that you enjoy and it can be fitted into your normal day, you are far more likely to keep doing it and see the benefits that it offers. Almost everyone can find some way of exercising around medical problems and disabilities, the links below will guide you to services local to you that can help you find a way to improve your fitness, increase your chances of a good and quick recovery, along with improving your health for the long term.

There are several schemes around Nottinghamshire to help you get fitter.

Local community to Nottingham Trent University Exercise Referral Programme | Nottingham Trent University
Nottingham West Exercise for Health - lleisure
Nottinghamshire County residents Physical Activity - Your Health Nottinghamshire (yourhealthnotts.co.uk
Hucknall and Kirkby Everyone Active's GP Exercise Referral Scheme

Reducing alcohol consumption

Excessive consumption of alcohol can lead to longer recovery and post-operative complications. We advise that those coming for any procedure or surgery reduce their consumption to within nationally agreed limits (14 units per week). Help can be sought from these websites:

Countrywide - Drink less - Better Health - NHS (www.nhs.uk)
Nottingham City residents only - Alcohol Advice - Your Health Nottinghamshire (yourhealthnotts.co.uk)

Achieving a healthy body weight

People who are overweight have an increased risk of many medical problems including heart disease, diabetes and strokes. Being overweight can also cause many life threatening complications with your surgery or anaesthetic and you should aim to optimise your weight prior to any procedure, in order to minimise risks to your health.

The NHS Body Mass Index calculator here, will give you an indication of where your weight currently lies with respect to the healthy body weight range. Those with a Body Mass Index over 30 are considered obese and in the Black and Asian population over 27.5 puts you a high risk of obesity related health conditions.

Most weight loss occurs with a significant change in your diet and not just exercise. It can be daunting if you are attempting to lose large amounts of weight but it is possible prior to your surgery. You can find weight loss tips on the NHS website and you may want to try their 12 week weight loss programme, available here Tips to help you lose weight - NHS (www.nhs.uk). There has been considerable success amongst patients who have followed a low carbohydrate plan prior to their surgery, this can result in significant weight loss and improvements in health. There is a lot of advice online regarding following a low carbohydrate diet, this free advice is available at www.diabetes.co.uk. Although this is aimed primarily at those with type 1 and type 2 diabetes, their advice and recipes are safe for non-diabetics. Some patients may wish to purchase literature around a low carbohydrate diet, it may be helpful to speak to staff at your appointment for further advice on this however Nottingham University Hospitals doesn’t endorse any individual plan.

At Nottingham University Hospitals Trust we rarely use weight as a barrier to surgery. However, in some circumstances a patient’s weight is directly correlated to poor outcomes from their surgery and a much higher chance of complications. You may wish to discuss your particular circumstances with your surgical team.

It is important that you do not attempt weight loss if your surgeon has advised against it.

Medications and Medical Conditions

If you suffer from any medical conditions, it is important that they are well controlled prior to coming for any procedure or surgery. This is the case even if the medical problem does not seem related to the surgery you require.

Complications from anaesthesia and surgery are more likely with poorly controlled medical problems and taking the time to improve your general health before coming for surgery is very important. Your General Practitioner is best placed to review any medical problems and ensure your medications are appropriate.

When you attend for your pre-operative assessment, we will ask you about your medical conditions and may delay surgery if we feel things can be improved prior to your operation.

Preparing for surgery

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