How to prepare for a Surgery?

In the former article about Surgery  we learnt about the basics of it.In the following article , we shall discuss about the preoperative preparation of a patient, from the patient's perspective, and also the technicalities of it. We will look into aspects of operative mortality, determining the risk of an operation and also learn about total parentral nutrition.
The patient's perspective

• The patient at a preoperative stage is usually in poor physical condition and sometimes also in not a very good psychological condition.
• The diagnosis itself is wrecking and the physical condition may seem to only worsen after that.
• The surgeon usually briefs the patient about the surgery that is to be performed.It is only natural for a patient to be anxious from that moment on. But it is extremely important for a good patient to trust the surgeon completely. It is important for the patient to know that his/her life is in extremely skillful hands.This gives them a sense of security and confidence.And this confidence can be gained only if there is good communication between the patient and doctor. Preoperative counselling is sometimes extremely necessary. This can be done by a skilled Psycho-oncologist as well as the Surgeon himself.

doctor communicating with patient

What is the need of preoperative preparation?

• Tumors have a variety of ill-effects on a patient's health.Some of the effects are often toxic in a manner that is disproportionate to the size and type of tumor.
• As a result of this, many patients suffer from poor nutritional status.This happens because, in cancers of mouth, pancreas, oesophagus, pharynx, etc, there is interference with normal alimentary function.
• Unexplained weight loss is known to be a symptom of cancer too.
• Morover, if pain is one of the horrible symptoms, this may lead to anorexia too.
• All these factors will make it difficult for the patient to cope up with the surgery.
• Hence, it is extremely vital that all or most of the nutritional deficits must be corrected before the surgery, because surgical mortality and morbidity rates are high in patients whose physiologic and biochemical deficiencies are not corrected first.
• Also, hypoproteinemia should be corrected and the blood volume should be restored.
• Total parentral nutrition is an efficient way of preparing a malnourished patient for surgery.

What is total parentral nutrition or TPN ?

• Total parentral nutrition is a method of providing ideal nutrition to patients who are undernourished.
• Here, a needle or catheter will drip TPN as per Doctor's advise.
• The TPN solution containing carbohydrates, lipids, proteins, minerals, trace elements, electrolytes etc, will be given as per the need.
• This will help restore the positive nitrogen balance before a major surgery:

How can one determine the risk in a given operation ?
This is based on a number of factors such as

• the physical condition of the patient, 
• other comorbidities
• cardiopulmonary reserve (function of heart)
• hepatic (liver) function
• renal (kidney) function
• the intent of this specific surgical procedure (curative versus palliative)
• the technical complexity of  the surgery
• type of anesthetic used, 
• the relative experience of the health-care personnel involved
• For more information, refer to 'the five level physical status classification of the American Society of Anesthesiologists' and the 'Eastern Cooperative Oncology Group five-step performance scale'

What is operative mortality ? 

• Operative mortality is defined as mortality that occurs within 30 days of an operative procedure.

There are 2 major factors that determine operative mortality:

• The underlying disease of cancer itself is a major cause of mortality.
• Old aged or geriatric population is more prone to surgical morbidity and mortality.

However, this factor cannot be used to disqualify them form a surgery which gives good odds of cure.

In case of operations for palliative purposes, it is better to avoid the risk by avoiding high-risk surgeries.
For example, If a patient has intestinal obstruction due to carcinomatosis, the surgery to relieve this will put the patient at 20-30% risk of mortality. In such situations, the risk:benefit ratio must be accurately calculated by the surgeon.

Also read
 5 reasons why you should study Oncology.
Cancer and surgery.
What is Radiation oncology?
What is Cancer-related fatigue?
What is psycho-oncology?
12 causes of cancer.
Cancer in 21st century.