Surgery 101: What you Need to Know

Having surgery is never fun-but if you are aware of some important issues, things may go more smoothly for you or for a loved one who you are helping. This is certainly not an exhaustive accounting of everything you need to know before having surgery, but I think this touches on some of the more common issues that can come up.

“Why can’t I eat the day of surgery?” This is a question that I hear often. Many people do not know that the reason we say to not eat or drink after midnight the day of surgery is because having a full stomach can be life threatening even for a minor procedure. Anytime that you have sedation or anesthesia, you may loose control of your airway. That is, if you become nauseated and vomit, you may have that fluid go into your airway and lungs. This can lead to a serious condition called aspiration pneumonia. It can necessitate that you are on a ventilator in the ICU after even a minor procedure.

And, so, when healthcare professionals say, “Nothing to eat or drink after midnight,” it is to be cautious about your safety. Now, if your surgery is scheduled for 3:00 pm, it may be reasonable to ask if you can push the midnight rule to 4 or 5 am. But, you are likely to be told that midnight is the rule. That is because surgery schedules can change and your case could be moved up several hours. If you have eaten or drank anything, that could cause a delay.

But there are times when the midnight rule requires adjusting. If the surgery is for a small child, you may be given instructions as to when to stop feedings which are closer to the time of surgery. This is because it is important not to allow small children to become dehydrated before surgery. But you should ALWAYS follow the instructions that you are given. Do not second guess what you are told. If what you are being told seems out of the ordinary, you can ask to speak with the surgeon or the anesthesia provider who is scheduled to do your case. Talking to these professionals may require several calls and you want to have your questions answered before the day of surgery so that you are clear on the instructions.

Similarly, if you are helping a very frail, older person to prepare for surgery, you may want to clarify the “nothing by mouth” instructions. Someone who is frail can easily become dehydrated and it may be possible to modify the instructions. But, again, be sure that you are getting the instructions from a qualified person who is familiar with your case. Otherwise, you risk having the case cancelled on the day of surgery.

What about taking your medications on the day of surgery? Too often, I have patients who say that they did not take any of their medications on the day of surgery. This is not always ideal. There are certain medications that it is best to take with a small sip of water rather than missing the dose. So, when you get the call from the doctor’s office regarding your pre-operative instructions be sure to take notes and verify at the end of the conversations that you understand the instructions. If you are just told , “nothing to eat or drink after midnight,” be sure to specifically ask about your medications.

How does smoking affect surgical risks? As healthcare professionals, anesthesia providers would prefer that you quit smoking all together! But as far as surgery goes, smokers can be at an increased risk when getting anesthesia. Even if you do not plan on quitting, it is best to refrain from smoking for the 24 hours prior to surgery.

Smoking causes constriction of blood vessels. That constriction can mean that your circulation is impaired and that can affect healing. You may be more susceptible to wound infection and poor healing, as a smoker. And general anesthesia can present challenges for a smoker. Commonly, smokers have a more reactive airway. So that when they are waking from anesthesia, there can be a lot of secretions and coughing. The secretions can cause a spasm in the airway and make waking up from anesthesia more complicated than it is for a non-smoker.

What is the deal with those consent forms? The informed consent process is vitally important and should not be rushed. Anytime you have a surgery or procedure you will be asked to sign a consent for which says that you have been informed of the risks. Be sure to take your time to understand what you are being told.

Often, to save time, a nurse or intern is asked to get your signature on the consent form prior to surgery. It is very reasonable to say that you do not want to sign the form until you have a conversation with the surgeon. You should be speaking to the person who is actually going to be doing the procedure. Questions will come up, and you want the answers from the person who is going to be responsible for your care. Please do not feel rushed or pressured at this important time.

Anytime a surgery or procedure is recommended, you want to ask: What is the goal of this surgery, what benefit are we hoping to achieve? And then ask: With my health history and at my age, what is the likelihood that I will see that benefit? And, always ask: At my age and with my health history, what are the specific risks to me of the surgery? Also, ask that question of the anesthesiologist or the nurse anesthetist who will be giving you the anesthesia.

Is it important for me to have someone with me before surgery? Yes! Even for an outpatient surgery, it is important to have someone with you so that there is another person who can ask questions that you may not think to ask.

When it the best time to have surgery? It can be advantageous to ask to be the first or second case of the day. That way you are less likely to be affected by unplanned delays in the surgical schedule. Of course, nothing is guaranteed, you might be delayed because of an emergency surgery or other issues. But it can be less likely if you are one of the first cases scheduled.

It is also best to be early in the day if it is an outpatient procedure where you are expected to go home the day of surgery. This is especially true for people who are of advanced age, and for those who have multiple medical problems. For these people who are more inclined to have any sort of complication, having the procedure done early in the day will give more time for things to get worked out in the recovery room so that they can be discharged home late in the day. Otherwise, if complications arise after surgery and it is 5 or 6 in the evening, the doctor may want to have the person admitted to the hospital overnight.

For people over the age of 70, having a hospital stay can make them even more vulnerable to other complications. Being in an unfamiliar environment can cause confusion, and risks of falls for older people, even those who are living independently. Therefore, it can be best to avoid an overnight stay in the hospital if that is possible. Read this blog post about the dangers of hospitalization for older people.

My last tip for you if you are having surgery or if you are helping someone with their healthcare is about prescriptions. If you receive prescriptions when you are being discharged, ask the staff to call them into your pharmacy (or to the hospital outpatient pharmacy). That way you will not be waiting for prescriptions to be filled when you are trying to get home the day of surgery. And if any sort of narcotic is being prescribed, be sure to ask about getting a stool softener or laxative to take with the narcotic. Narcotics such as norco, vicodin, oxycontin or percocet can be constipating. You definitely do not want to be recovering from surgery and get constipated.