American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

How Can I Be “Strong for Surgery?”

Every year, 15 million Americans have some kind of surgery. If you are going to have surgery, it is important to learn about the potential risks you might face, and what you can do to prepare so that you have the best possible results. You have an important role in your recovery.

Strong for Surgery is a program that works with surgeons and hospitals to provide tools like checklists that surgeons can use to assess your risks in four target areas: nutrition, blood sugar control, smoking cessation, and medications. You can lower your risk by being better prepared for your operation.

Strong for Surgery has developed tools and resources for patients facing surgery that are available here on the website. We suggest that you use them when you talk with your doctor. Bring copies of the checklists along to your visit and ask your doctor if any of these things would be helpful for you:

Eat Well

It is important to eat healthy foods before your operation. Tell your surgeon if you have trouble eating or if you have not been very hungry. Also tell your surgeon if you have lost weight without trying or cannot eat at all. Your surgeon may want you to see a dietitian, who can help you work out an eating plan. A lab test called an “albumin” level may be ordered to see if you are at extra risk for problems after your operation because of your nutrition or for other reasons.

Quit Smoking

Smoking increases the risk for many problems after your operation. It can:

  • Make it hard for you to breathe
  • Make an infection in your wound (incision) more likely
  • Increase your chance of having a heart attack

Ask your surgeon about how to quit smoking. Quitting will not only reduce these risks, it will also improve your overall health and even add years to your life.

Blood Sugar

If you have diabetes, you know how important good blood sugar control is. Your surgeon needs to know what your recent blood sugar test results have been. On the day of your operation, your surgeon should check your blood sugar before your operation. Having an operation puts stress on your body, and stress can affect your blood sugar level. Blood sugar that is too high or too low can cause serious problems. Keeping blood sugar in control before, during, and after your operation will reduce your risk of infection in your incision and will help you heal better.

Even if you haven’t been told you have diabetes, your doctor may want to check your blood sugar. Many people have high blood sugar and don’t know it.


Your doctor needs to know what medicines, over-the-counter drugs and supplements, and herbal remedies you are taking. Some of these can increase your risk of bleeding. Your surgeon will tell you which ones to stop taking—and when to stop them—before your operation.

Some medicines should not be stopped. If you are taking one of these, your surgeon will make sure the hospital staff knows so that you get the right medicines before and after your operation.

Safe and Effective Pain Control

Controlling your pain after your surgery is important aspect of recovery. To help you have a successful surgical experience, it is important for you to have a presurgical discussion with your surgeon about how he or she will work with you to manage your pain.

Your physician may discuss using a combination of strategies to control pain. These alternative ways to control pain can be helpful and sometimes may provide better pain relief than medication alone. You may also be screened for current opioid use and potential risk for overuse. To ensure the safety and most effective way to control people the physician may advise using the lowest dose of opioids, safely getting rid of unused opioids, and knowing the signs of opioid overuse. The clinical team want to make ensure that you are informed about managing your pain in a positive manner. 


More than 7 million hospitalized Americans suffer from delirium each year. Delirium is a state of confusion that comes on very suddenly and can last from hours to days. The elderly are particularly impacted with delirium relating to a hospital admission, but bear in mind that a number of different things can cause delirium. Your surgeon and health care team will work with you and your family to screen for risk factors, and may possibly refer you for further evaluation and give your caregiver tools on how to manage delirium should you experience it.


Prehabilitation is defined as a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand any postoperative inactivity and associated decline. In other words, to get you to a better place physically before an operation. Generally, the more fit and active you are going into a surgical procedure, the more likely you are to retain a higher level of function after. It is important for you to know and work on any functional deficits prior to your operation.

Patient Directives

Having an operation can be overwhelming. There are many things to consider before going in for surgery. The health care team may provide you with specific information related to the operation you are having. Review this material as it may help you understand what to expect from the procedure. Another topic to consider discussing with your surgeon are the costs related to the procedure. You may be referred to a social worker or a financial counselor to discuss the costs and payment options. Care provider details will also need to be discussed and confirmed. During this discussion, it may be helpful to go over advance directives and your living will options. They may not be needed for the procedure, but will help you establish them for yourself and your family.


Preparing for Surgery