What is presurgical stress?

No matter how you look at it, surgery is a stressful situation. It’s not uncommon for patients facing an upcoming operation to be anxious and worried. The most common fears are

• fear of pain and anesthesia,
• anxiety about the possibility of medical complications, and
• the need to rely on a stranger¹.

Unfortunately, pre-surgical stress and anxiety are unavoidable. One of the roles of anxiety is to protect us from situations that we consider dangerous. It primes the body to defend itself or quickly escape from a perceived threat. This is what’s commonly known as the fight or flight response. It can trigger symptoms like

• a fast heartbeat,
• anxiousness,
• nausea,
• shortness of breath,
• or difficulty sleeping.

What happens to your body during surgery?

There are two ways you will experience stress during your surgical process. You may feel stress or anxiety before your surgery when you think about the procedure. However, another type of stress occurs. This stress happens during surgery and is referred to the surgical stress response.

Your body’s natural response to surgery is a “stress response”.  A surgical stress response triggers a cascade of reactions. First, your nerves send signals from the surgical site to the hypothalamus, subsequently producing the CRH hormone.  CRH stimulates the release of ACTH from the pituitary gland, after which ACTH stimulates the release of cortisol from the adrenal gland².  During the surgical stress response, the stress signals are continuously sent to the hypothalamus, and cortisol levels remain high as cortisol is continuously released.

During recovery, high cortisol levels

• suppress the immune system;
• increase blood pressure and sugar;
• inhibit bone formation;
• increase protein catabolism; and
• slow wound healing².

As this is a natural part of surgery, your surgeon does everything he/she can do reduce the effects. However, you can take steps to reduce your anxiety and stress before surgery. While anxiety is appropriate for certain situations, when it comes to surgery, these symptoms can actually have a negative effect on the post-surgery recovery period. Studies have found that high levels of emotional pre-surgical stress are linked to higher blood pressures and a higher use of pain medication in the post-surgery period¹.

It’s important to try to manage the anxiety as much as possible.  Below are some things you can do to help reduce your anxiety about any upcoming procedures.

 1- Arm yourself with information

Find out the specific details about your operation. You don’t necessarily need to know the minutia of what instruments the surgeon is going to be using. However, find out

• what will happen the day of the surgery,
• what ward you’ll be on,
• the expected length of the procedure,
• expected side effects,
• what pain medication will you be given, and
• how long the recovery process will take.

The more information you have, the more uncertainty you can take out the equation. Usually, people tend to feel more in control when they know what to expect.

2- Prepare your body

Surgery puts your body under a huge amount of physical stress. Your body will need all the resources possible (in the form of good nutrition) to help

• boost its immune system,
• fight off infections, and
• have a swift recovery.

Sticking to a healthy diet in the weeks leading up to surgery is important. Getting all the vitamins, minerals, and nutrients you need helps promote tissue healing and a swifter recovery. For those not able to get all their daily recommended vitamins and minerals, consider using supplements. Obtaining proper nutrition before surgery can also inhibit the surgical stress response.

Nutrition targeted toward surgery can inhibit the toll of surgical stress and reduces surgical risks by supporting your body with the nutrition needed for

• wound healing;
• tissue repair;
• regulated protein metabolism; and
• complete recovery.

Your surgeon will most likely tell you to stop taking supplements prior to surgery. This is because some nutrients act as blood thinners which are dangerous during surgery. The most common blood-thinning agent is vitamin E. Do not take supplements that contain vitamin E before your surgery

If a supplement does not have blood-thinning ingredients, talk to your doctor about their continued use. Make sure that your supplement is pharmaceutical-grade and designed for addressing pre-surgical needs.

3- Talk to your surgeon

Don’t be afraid to ask questions, that’s what doctors are there for. Ask questions about anything you are concerned about.

If you still want more information, request a pamphlet or flyer. Most doctors and surgeons have written material that explains different surgical topics. You can also do your own research. Do be careful when researching on the web. Make sure the source of information is credible.

4 – Explore Alternative Treatments for Surgical Anxiety

Some people find that now is a good time to try a few alternative relaxing techniques. These techniques may include yoga, tai-chi, or even a new hobby. These types of therapies tend to

• lessen anxiety,
• ease stress, and
• provide a good coping mechanism.

Exercise is a great way to reduce stress in general. Participating in safe exercise, especially before surgery, can help reduce anxiety and stress.

5- Ask about any patient resources for pre-surgical support

Many hospitals offer special support services to people undergoing surgery. Find out if your hospital has such a program. It can be a mixture of

• talking about your concerns with a designated staff member,
• a quick walk-through of the process, or
• literature specifically designed for pre-surgical patients.

Don’t forget that family and friends can help too. Just voicing your concerns to someone else can be really helpful.

 

As mentioned, stress is an inevitable part of undergoing surgery. Some stress you can control and some you can’t. Whether preparing for surgery or amidst the operation, your body reacts to stress. Whatever you or your doctor can do to reduce that stress will be beneficial.

 
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1) Marek, M., & Małgorzata, K. (2015). [Effect of pre-surgical stress on recovery of patients undergoing hip replacement procedures]. Przeglad lekarski, 73(1), 25-28. https://www.ncbi.nlm.nih.gov/pubmed/27120945

2) Finnerty, C. C., Mabvuure, N. T., Ali, A., Kozar, R. A., & Herndon, D. N. (2013). The Surgically Induced Stress Response. JPEN. Journal of Parenteral and Enteral Nutrition, 37(5 0), 21S–29S. http://doi.org/10.1177/0148607113496117