I recently gave a presentation at the Texas Orthopedic Association annual meeting and was part of a panel that included surgeons Dr. Creighton Tubb (New Braunfels Orthopedics) and Dr. Christina Brady (VA) and which was moderated by OrthoLoneStar Chief Medical Officer, Dr. John McDonald . (I’m Eziah Syed, Co-Founder, Chief of Growth & Innovation at Mend and a passionate advocate for leveraging surgery as a catalyst for long-term behavior change.) Our discussion topic was "ERAS 2.0", how we can leverage all of the latest science, tools and technologies to further enhance surgical outcomes, patient experience and the surgeon's business model.
As we had envisioned our Upgraid platform, one of our earliest intuitions was that surgery could serve as an opportunity for behavioral change. In my presentations to investors, clients, etc. I would often cite my eldest brother as an example. For many years he was not particularly attuned to investing in healthy eating or exercise. That all changed when he had to have a gall bladder removed. As if overnight, nutrition, exercise and healthy living rose up to the forefront of his awareness and it's now a creed he lives by. His illness and surgery was the catalyst.
Major surgical procedures are often perceived as endpoints in the continuum of care. Yet, a growing body of research highlights that surgery can serve as a “teachable moment”—a psychologically potent opportunity to influence long-term health behaviors. Evidence suggests that patients facing surgery are uniquely receptive to health interventions, with heightened motivation to adopt behaviors that can improve surgical outcomes and long-term well-being. Dr. Andrew Wickline has grilled into my head that a total joint surgical episode of care is roughly 3000 hours (2 months pre op and 2 months post op). If we have 3000 hours with a patient when they are most receptive to behavioral change, what's possible? Isn't this a significant missed opportunity to improve human health? We can't undo what got the patient ill, but we can certainly help them with new behaviors that will improve their health going forward.
This is why I was so pleased at the TOA annual meeting when Dr. Tubb pulled up a slide called "Surgery as a Teachable Moment". He showed graphics demonstrating how smoking cessation is incredibly effective during surgery (the graphic below is mine, not from Dr. Tubb's presentation).
The Concept of a “Teachable Moment” in Healthcare
A teachable moment refers to a naturally occurring health event that motivates individuals to adopt risk-reducing behaviors. Surgery, especially elective procedures, often prompts patients to reassess their health, driven by fear, worry, anxiety, the desire for optimal recovery, and increased contact with healthcare professionals. These elements create a window of heightened readiness for change—one that providers can intentionally leverage.
Among all behavior interventions, smoking cessation during the perioperative period is the most studied. Research shows that up to 50% of smokers who receive preoperative smoking cessation counseling will quit prior to surgery, and 20–30% maintain abstinence six to twelve months postoperatively. The risk of postoperative complications—including wound infections, cardiopulmonary issues, and delayed healing—provides immediate consequences that make the risks of smoking more salient.
Dr. Tubb talked about the role of the surgeon and his sense of personal responsibility in playing a more important role in the overall well-being of his patients. He surmised, why couldn't he view the surgery as an opportunity to position the patient for long-term health success.
Obesity is a well-established risk factor for poor surgical outcomes, including infections, longer hospital stays, and readmissions. Yet, it is rarely addressed in a structured way during preoperative planning. Emerging studies suggest this is a missed opportunity.
Functional decline is a known risk after major surgery, particularly in older adults. Prehabilitation programs—structured interventions that improve functional capacity before surgery—have demonstrated improvements in outcomes ranging from postoperative complications to hospital length of stay.
The days and weeks leading up to surgery often trigger anxiety, reflection, and a re-evaluation of one’s lifestyle. This psychological readiness creates fertile ground for behavioral intervention.
With healthcare moving toward value-based models, leveraging surgery as a teachable moment aligns clinical outcomes with cost containment.
Surgery is more than a clinical intervention—it’s a psychological turning point. The vulnerability and reflection it induces can be used to spark lasting behavior change. Recognizing and institutionalizing surgery as a teachable moment could significantly advance patient care, reduce complications, and promote well-being long after the sutures are removed.
It's time we start using surgery as a teachable moment. Our Upgraid platform and program has behavioral change as a core tenet of what we're endeavoring to achieve.
This article was written by Eziah Syed, Co-Founder, Chief of Growth & Innovation at Mend.
