By Reginald Griffin, MD & Thomas G. Peters, MD, FACS, FASN

So, you are having an operation! By this point you have consulted with your surgeon, for whatever reason, and have decided to go forward with surgery. Perhaps all the questions you wished you had asked the surgeon while in the office are just now coming to mind. Now what? First of all, don’t stress out. You will come across a host of people who will help you through this venture, but there are some important points that you need to consider regarding your surgical experience. Remember, personal responsibility plays a huge role in preparing for any surgery.

There are three parts to the pre-operative period: the days or weeks leading up to surgery, the night before surgery, and the morning of surgery.

First, let’s begin with days or weeks leading up to surgery. The activities during this time are crucial to get maximum benefit, best healing, and faster recovery after surgery. If you have been to a doctor before then you almost certainly have heard the dreadful phrase “life-style modification.” In other words, get into shape! There are three rules to abide by: exercise, eat healthy and stop smoking. Here is why:

Aerobic exercise like daily walking, bicycling, or swimming improves your lung function. In addition, practice your deep breathing. For instance, repeatedly blowing up a balloon can be very helpful. The idea behind aerobic exercise and deep breathing is to expand the tiny air sacs in your lungs called alveoli to their greatest potential. After anesthesia, the alveoli can collapse and cause a condition called atelectasis which can lead to fever and pneumonia. Effective breathing will help prevent atelectasis.

Improving your nutritional status will help your body heal better after surgery. One of the ways your surgeon will assess nutritional status is by testing the level of a protein call albumin in a routine blood test. Research has shown that low levels of albumin are associated with worse outcomes in patients undergoing surgery or hospitalization. Attention to nutrition is even more important for patients with diabetes; blood glucose levels should be between 90 and 110. High glucose levels are toxic to cells and will disrupt normal wound healing.

Stop smoking. Easy for surgeons to say, but they have good reason. Cigarette smoke causes poor wound healing in two ways: nicotine causes blood vessels to constrict which decreases the oxygen rich blood supply to the cells of the wound. There are also many toxins in smoke that impair wound healing. This is a good time to kick the habit and help make your scars less noticeable.

If you take blood thinners such as warfarin, aspirin, or Plavix, your surgeon will instruct you to stop taking those 5 to 7 days before surgery. Anti-inflammatory medications and certain vitamin supplements such as vitamin E, ginko-biloba or garlic can cause increased bleeding so disclose all of your medications and supplements to your surgeon and anesthesiologist.

Pre-admission testing is usually the day before surgery. The purpose is to draw labs and possibly get an electrocardiogram or a chest X-ray. The night before surgery is a time to relax. Have a nice dinner or go see a movie; just remember you cannot eat or drink after midnight, so do not drink coffee the next morning. Your surgeon may instruct you to take your blood pressure medicine the morning before surgery and you may do so with small sips of water. Your stomach should be empty so that you do not vomit during anesthesia.

The day of surgery, have someone accompany you to the hospital or surgery center. That person’s job is to be your advocate, help you ask questions before surgery and help you remember the surgeon’s instructions after surgery. There will be a team of people taking care of you. The pre-operative nurse will settle you in. You will be seen by the anesthesiologist, the operating room nurse and the surgeon. Remind the team if you have any drug allergies, as many patients will be given antibiotics before surgery to help prevent skin infection. Your lower legs may be fitted with compression devices to prevent blood clots. Ask your surgeon about recovery time and when you may safely resume activities of daily living and return to work.

Remember, the best way to prepare for your surgery is to exercise, eat healthy and don’t smoke. Review the pre-surgery checklist to help your operative experience go as smoothly as possible.

Pre-surgery Check List 
♦ Any changes in your health (even minor ones such as a cold or cough) should be reported to your surgeon or anesthesiologist prior to your surgery date. 
♦ Follow orders given to you by your surgeon or anesthesiologist, and obtain any lab work or tests your physician may have ordered prior to the day of surgery. 
♦ If you suspect that you are pregnant, please notify your physician prior to your surgery date. 
♦ Refrain from smoking. 
♦ Do not eat or drink anything after midnight. 
♦ Bathe or shower and brush your teeth (taking care not to swallow any water) the
morning of surgery. 
♦ Remove all makeup, nail polish and contact lenses. If you must wear contact lenses, please bring your storage case for use during surgery. 
♦ Leave all jewelry, cash and valuables at home. 
♦ Arrange for a responsible adult to accompany you, stay with you while you are receiving care, drive you home and stay with you for the first night following surgery. 
♦ Limit the number of people who accompany you. We suggest that adult patients be accompanied by only one person. We do welcome both parents of pediatric patients. 
♦ Bring all insurance cards and proper identification such as a drivers license. It is important for us to have all the current and correct information. 
♦ Bring any paperwork your physician may have given you at your office visit. 
♦ Bring a special cup, bottle, blanket, pacifier, etc. for pediatric patients.

Dr. Griffin is originally from Ocala, Fla. and is a graduate from the University of Florida. He graduated from Saba University School of Medicine and is currently a third year resident in General Surgery Residency program at the University of Florida, Jacksonville campus.

Dr. Thomas Peters is the Professor of Surgery and Chief of Transplant at the University of Florida and Shands in Jacksonville, Fla. He currently serves as a member of the AAKP Medical Advisory Board, Medical Editor of aakpRENALIFE and is Board President of the National Kidney Foundation of Florida.

This article originally appeared in the July 2010 issue of aakpRENALIFE.

Posted 8/10/2010.

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