I read an interesting paper published this year  entitled “Can we measure surgical resilience?” It is just a hypothesis at this stage, but the authors are looking at whether there are biomarkers in patients that can measure psychological resilience associated with improved surgery recovery and healing.
They define resilience as “the ability to accept circumstances that cannot be changed, and to adapt to significant changes in the environment.” Based on this definition, they are investigating different biomarkers that can distinguish high resilience from low resilience, with the idea that these biomarkers could then be prognostic of surgical recovery. Once identified, the goal then would be how to utilize these biomarkers to find ways to optimize the resilience of low resilient people before they go into surgery, thus leading to better recovery.
Three biomarkers being considered are:
- Neuropeptide Y – with high levels associated with better psychological outcomes and low levels associated with increased anxiety levels
- Testosterone – high levels promote social connectedness and positive mood, both of which are associated with resilience. Levels decrease following acute stress and are associated with post-traumatic stress disorder and depression
- DHEA – this is involved in the HPA/stress axis with high levels associated with improved outcome
While specific predictive biomarkers have not yet been determined, there is plenty of evidence to show that improving coping skills, and reducing stress and anxiety before surgery improves outcome. Surprisingly, the evidence also shows that dealing with the psychological aspects of surgery has a greater influence on recovery than the physiological aspects.
So what can we do to prepare for surgery?
Many studies have shown that using guided imagery can help people heal faster, have less anxiety, less post-operative pain, less blood loss, and get out of the hospital quicker. Some hospitals “prescribe” guided imagery before and after surgery for all their surgery patients. And not surprisingly, as the data is strong.
The goal is to start guided imagery, at least, a week before surgery, but preferably earlier, if possible. There are several online guided imageries you can use including one by Sutter Health, but take a look and see what you can find that helps you.
Also, there are a couple of books and recordings. I like Martin Rossman’s book “Fighting cancer within” which has different guided imageries for different situations in cancer treatment, including surgery, chemotherapy, radiation, etc. A book/recording just for surgery is “Prepare for surgery, Heal Faster” which has been used in many hospitals, and Belleruth Naparstek has a CD of surgery imagery “A meditation to promote successful surgery“.
Maybe you’ve never tried guided imagery before and think it’s a little weird – but it is worth a try. Sometimes it can depend on the voice talking so if you don’t like a recording, you can use the transcript and either record your own voice reading it, or ask your loved one or friend to read it to you.
While preparing psychologically is important, physical health is also worth considering. Some things you can do to prepare physiologically/physically for surgery include:
- optimizing your diet so you get lots of nutrients, vitamins, and minerals;
- getting some exercise in the weeks prior to surgery, if you are able to;
- getting enough sleep; and
- adjusting your supplements where necessary as some may increase your risk of bleeding (e.g. aspirin, omega 3 fats, Gingko Biloba, St John’s Wort, etc.) or may interfere with some anesthetics (Echinacea, Gingko Biloba, St John’s Wort, Ginseng, etc.).
Discuss these with your surgeon/healthcare practitioner.
Until we have biomarkers that can distinguish between who is likely to recover well from surgery and who isn’t, we should just all try and improve our resilience, both psychological and physically, for the best possible outcome. There really isn’t a downside to good preparation, and potentially we have lots to gain.
 Graham D, Becerril-Martinez G, Quinto L, & Zhao DF (2016). Can we measure surgical resilience? Medical hypotheses, 86, 76-9 PMID: 26804602