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How To Prepare For Surgery


Once you agree to have surgery, before entering the hospital, consider the following:

Give your surgeon:

  • A list of all your current medications,  herbs, supplements, vitamins, and allergies 
    • You may have to stop taking some drugs and herbs before surgery. For example, Ginkgo, the supplement, and Nonsteroidal anti-inflammatory pain relievers (NSAIDs) such as ibuprofen and naproxen, can cause excess surgical bleeding. The only way to know which drugs and supplements to stop, if any, and how far in advance of the surgery to stop, is for your doctor to review the complete list. We provide an interactive List of Medications to help you keep track, and to keep the list up-to-date.
  • Any special dietary requirements
    • The surgeon can make sure your dietary requirements are met if she or he knows about them ahead of time. For safety, check with the surgeon's office manager a few days before going for the surgery to be sure your requirements are known to the hospital or other facility.
  • If you have a pacemaker and/or defibrillator
    • Your surgeon will likely want details about manufacturer and type.
    • Your surgeon may want a representative of the company on site to turn the device off and on.
  • A copy of any Advance Healthcare Directives that provide what to do about healthcare in case you become unable to speak for yourself.
    • If you haven't executed these documents, particularly consider a Health Care Power Of Attorney which appoints a person to speak for you as your proxy.  (Also tell him or her that we have an article about how to enforce your wishes if there is a problem with the doctor or hospital).
    • Advance Healthcare Directives are easy to obtain and are free.
      • While thinking about Advance Healthcare Directives, also consider what you want to happen if you lose your mental abilities and need to have a health care decision made for you. The document that covers such a possibility is known as an Advance Directive For Mental Health.
    • NOTE: If you have a Will, make sure it is up to date. If you do not have a will, it does not have to be expensive to write. In fact, it may even be free. For information about wills, click here. For information about how to make a will challenge proof, click here.

Schedule surgery for a day and time most likely to maximize your care.

  • Ask your doctor if your surgery can be scheduled first thing in the morning on a Tuesday, Wednesday or Thursday.
  • Scheduling surgery for first thing in the morning has many advantages.
    • Your surgery is more likely to start on time and not scheduled for later or another day if it is scheduled in the morning.
    • You will require the most care during the immediate postoperative hours, which can be supplied by the day shift when the staff is at full force. Hospital staffing is generally reduced on night shifts.
    • You will generally not be allowed to eat or drink for eight hours before general anesthesia. The ban typically begins at midnight, so the earlier the surgery, the shorter the fast. If surgery is delayed, the no food period can go on and on. (See below if this time period is too long for you.)
  • Scheduling surgery for Tuesday, Wednesday or Thursday also has several advantages:
    • Monday is not a great day because non-emergency surgeries are sometimes delayed or even postponed due to an influx of emergency cases from the weekend.
    • If your surgery is scheduled for a Friday, you may receive reduced postoperative care on the weekend when hospital staffs are reduced, or get short shrift from a doctor who wants to get away for the weekend.

With the surgeon:

  • Discuss pre-operative tests. Only have tests that are necessary
    • Surgery patients are usually required to have a variety of "standard" preoperative tests. These tests may include a blood count, blood tests for diabetes, kidney and liver disease, an electrocardiogram (EKG), and chest x-ray. Some of these tests may be unnecessary depending on your age, medical condition, and the specified surgery. Sexually active women of childbearing age are generally required to take a pregnancy test.
    • Ask your doctor to review the tests and limit them to only those that are essential.
    • Remind your doctor of any recent tests that were performed.
    • Ask the doctor to use one sample for all the necessary tests. (Remind the nurse who actually takes the sample.)
  • Discuss the use of antibiotics
    • Standard procedure is for antibiotics to be administered before or during surgery to help prevent infection. Confirm with your doctor whether antibiotics will be used and, if so, when they will be given. If you know the intended plan, you can follow-up to make sure it happens.
    • While you're at it, ask the doctor about whether he or she proposes to prescribe antibiotics after surgery. Routine prescribing of antibiotics has led to many forms of drug-resistant bacteria. As a result, some doctors may be under-using antibiotics. If your surgery poses a significant threat of infection, discuss with your surgeon the benefits of receiving antibiotics on a continuing basis. 
  • Discuss your thoughts about pain relief and ask for a standing order
    • Studies show that adequate pain management after an operation promotes healing. In addition, pain management after surgery can help to prevent or decrease stress and depression.
    • Discuss your needs with your surgeon and anesthesiologist before your surgery  If you are a woman, discuss the possibility that you may need extra medication during and after the operation to control pain. Women have lower pain tolerances than men and may also experience less relief from drugs used to manage pain.
    • Agree on a plan for pain medication while in the hospital. Ask the doctor to place a standing order for pain relief in your chart so you can get pain meds when you need them.
    • Also get the prescription you'll need to continue pain medication at home. If you fill the prescription before your surgery, you'll avoid the possibility of a time lapse without medications after you return home.  
      • It is generally advised that patients stay ahead of post surgical pain rather than wait for pain to occur and then take medication to reduce or eliminate it. 
      • Once the drug is agreed upon, the question becomes how much and when to take it. For example, it is not uncommon for a drug to be prescribed "take one or two, every four to six hours." Talk with your doctor about the possible strategy for at least the first few days you are home of taking the maximum daily amount - such as taking two pills every 4 hours - including in the middle of the night.
      • If the drug is a narcotic, it may have the unwelcome side effect of causing constipation. The more of the drug you take, the more likely you'll experience this side effect. Relieving constipation once the post surgical pain period recedes may cause its own difficulties in your life - especially if you end up with a day or two of diarrhea. It is advisable to discuss the trade off and decide which works best for you.
      • Ask about mild techniques for relieving constipation while taking pain medications such as a stool softener and/or Mineral oil.
    • For information about questions to ask before agreeing to take a medication, click here. For information about saving money when purchasing medications, click here.
  • What you can do to build up your body to maximize its healing ability.
    • For example, for at least the 10 days before the surgery, eat properly, drink lots of water, exercise appropriately, get sleep and stop smoking. Stopping smoking ten days before surgery will help move oxygen through your lungs. Maximum oxygen delivery is one of the keys to fighting off infection.
    • Some doctors suggest drinking 8 to 10 glasses of water every day. If you are dehydrated, surgery can cause blood-pressure complications and make you more susceptible to infections and shock.
    • If permitted by your surgeon, take a multi-vitamin during that week to build up nutritional reserves to help healing. Do not take herbs or other supplements without approval by your surgeon.
    • Work with your therapist or your support group to get into a positive state of mind. Keep the focus on the half full side of the glass.
  • Talk about food and liquid before and after surgery
    • Traditionally:
      • No food or liquid was allowed after midnight the night before surgery -- no matter what time the surgery was scheduled for.
      • No food was allowed after surgery until after until gas passed or bowels moved.
      • Both of these standards were based on tradition, not scientific evidence.
    • Many surgeons still follow tradition. If the traditional method doesn't work for you, remind the surgeon:
      • Food and Liquid Before The Procedure: American Society of Anesthesiology revised guidelines in 1999 to permit clear liquids, a light meal or a regular meal much closer to the expected time of surgery. They permit clear liquids such as water, clear tea, black coffee, carbonated beverages and fruit juice without pulp, two hours before scheduled surgery. They also permit a regular or heavy meal eight hours before.
      • After Surgery: Afterward studies show that bowels do not shut down during surgery except in rare instances so patients can start eating low residue diets the morning after surgery. Low residue diets include such foods as mashed potatoes, scrambled eggs or pancakes. Interestingly, early feeding has resulted in lower hospital costs and improved postoperative quality of life.
    • After discussion with the surgeon, it is advisable to follow his or her advice.
  • Discuss your comfort in the operating room
    • There is evidence that people can hear what is being said while under general anesthesia. "Just in case:"
    • Ask your surgeon to make positive statements in your hearing range about the surgery as it progresses.  Ask that discussions about negative aspects take place outside of your hearing if possible.
      • Consider making arrangements to hear music you consider soothing during the operation. If the surgeon doesn't mind, the music could be piped through the operating room sound system. Alternatively, you may be able to take your MP3 or other music player into the operating room and listen to your music via headphones. 
    • Some hospitals will allow a loved one to be in the operating room.  Studies have shown that this can be beneficial in terms of less worry and stress to the patient undergoing the surgery.         
  • Ask the doctor to mark the spot which will be operated on
    • We have all heard the horror stories of surgeons removing the wrong limb or operating on the wrong side of the brain.  Although these accidents are rare, they are 100% avoidable.  The American College of Orthopedic Surgeons recommends that its members initial the surgical site before the procedure.  Ask your surgeon to follow the recommendation. The mark will not be permanent.
    • Participate in the marking.  Watch to make sure the correct site is marked (or ask a friend or family member to do it for you if the site is out of your site line)
  • Find out whether you will be given blood during the surgery, or whether there is a likelihood that you will need blood. If  so, consider banking blood.
    • According to the Harvard Medical School, Harvard Health Letter, advantages of banking your own blood are:
      • It lowers your chances of getting certain blood-borne diseases from a transfusion. Since the risk of infection is small, the advantage of avoiding it is similarly small.
      • Averts possible adverse immune responses.
      • Gives peace of mind.
    • The disadvantages are:
      • It wastes much of the blood. Between one-third and one-half of all autologous blood donations are thrown out, compared with less than 10% of the blood collected from other donors.
      • Adds to health care costs. Even if the hospital doesn't add a surcharge for autologous donation, it costs more.
      • May lead to anemia.
      • Increases the likelihood of receiving a transfusion.
    • If you do bank your own blood, be prepared to give early and often. Blood can't be stored in a non-frozen state for more than 42 days. A month in advance of your surgery is the outside limit for contributing.
    • Consider asking your friends and family to donate for your account.
    • You will not be charged for using any blood up to the amount in your account. If there is excess blood, it will go to a blood bank to be used by people who need it. There is still no replacement for blood.
    • For more information, contact your local Blood Bank, your doctor's office, or the hospital. You can find your local blood bank at: offsite link, click on the box which says: "Click To Find Your Local Blood Center."
  • Ask how to obtain a copy of the consent form you will be asked to sign before surgery.
    • You will be required to sign a consent form prior to your procedure. This often happens just before you will be wheeled into the operating room when you won't have time to think about the contents of the form and may feel pressured to sign it.
    • Ask your surgeon or his or her office manager to let you see the form at least a few days ahead of time. That way you can review the form, ask questions, and discuss any problems you may have.
    • Even though the consent form will likely look like a standard form, it can be amended.
    • Make certain that the consent requires the surgeon you have chosen to perform the surgery (or at least to be present in the operating room). If the form states that "doctor Y or his associates or assistants" will be present during the surgery, you may end up with the associates or assistants in the operating room, rather than doctor Y. If your surgeon wants other doctors to help, the consent should read, "Dr. X and associates" or "and assistants." The and assures that the doctor you think will be performing the surgery will actually be present at the surgery.
    • Before signing, make any changes you want in ink. Then initial the changes.
  • if you smoke, quit. While we provide information about quitting smoking, one of the resources to consider to help you quit is to speak with your doctor. He or she may have medication or other suggestions.
  • If you will be in the hospital:
    • Ask how to get a sunlit room post surgery, Studies indicate that patients who were placed in sunlit rooms after surgery reported less pain and took less pain medication than those in darker rooms.
    • Preferably a sunlit room that also looks at nature (or at least has a picture of nature in your room.) At least one study indicates that looking at nature can help healing.
  • Plan for your post-surgical needs to the extent you can. For instance:
    • Arrange for help if you will need it, both for yourself and your enviornment. If you will rely on friends and family, set a schedule that describes the needs you anticipate and who will fill them at what times and on what days.
    • if you won't be able to go out of the house for a while, you'll either need to stock food or make arrangements for deliveries.
    • Prepare your environment. Perhaps you need to move where you sleep to an area that doesn't require you to walk up and down steps - or stay with someone for a while that has easier access to bath and kitchen facilities.
    • Change your sheets before going in for surgery so you return to a clean, pleasant bed.
    • Pull out extra blankets in case you get a chill.
    • What will you need in your regular life. For instance, are there birthday cards you normally send, or maintenance on your house that needs to get done at a specific time.

With the anesthesiologist:

  • The anesthesiologist is in charge of keeping you asleep, and checking your vital signs, during an operation.
  • Usually patients do not meet the anesthesiologist until just before the surgery.
  • While it's an additional burden at a stressful time, it helps if you can remember to have your List Of Medications handy so you don't forget anything when talking about the drugs, herbs, vitamins and supplements you take.
  • Tell the anesthesiologist if you suffer from sleep apnea or acid reflux. Sleep apnea is a disorder in which breathing is temporarily interrupted during sleep. Acid reflux is a condition that allows stomach acid and enzymes to flow backward from the stomach into the esophagus.

Place in which the surgery will be performed

  • If the surgery will be in a hospital where you stay at least overnight:
  • If the surgery will be on an outpatient basis:
    • Find out what alternatives are available in the event that an emergency happens. For example, what emergency equipment is available? Are doctors in other specialties available if needed?
    • Check with your insurer to be sure it pays for a procedure performed in a doctor's office or other non-hospital setting. There may be other doctors' offices or non-hospital settings which are approved for payment. An alternative is a free-standing surgical center. They are usually better regulated than doctors' offices. Most states require hospitals to be licensed, usually by the state health department.
    • Make plans for a family member or friend to pick you up after the procedure.
    • To learn more about out patient operations, click here.

Additional Pre-Surgical Tips

  • Don't shave the area that will be operated on by yourself before surgery. 
    • Shaving the area yourself can increase your risk of infection. Surgery causes microscopic abscesses on the skin which can become infected. Let the staff trim the hair before surgery to minimize the time you're vulnerable.
  • Tell your doctor about any cuts and scrapes, no matter how small or unrelated to your surgery.
    • Let the surgeon decide whether infection is a risk to be dealt with, and if so, how.
  • Don't take rings and other jewelry to the hospital.
    • Jewelry can harbor germs and can be stolen while you're not conscious.
  • If you will take a mobile device, be sure that everything on the device is backed up elsewhere in case it goes missing
  • Do what you can to reduce pre-surgery stress.  Surgery is stressful. Stress reduces the body's ability to fight infection. For information, see: Stress 101, How To Avoid Unnecessary Stress,  Techniques For Coping With Stress

Paying for your surgery

NOTE: For additional information, see:

Written With: 
Herbert Spiers, Ph.D., New York, NY

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