Preparing for Surgery

• A hospital representative may call you to verify your insurance and personal information.
• You will need a call with the preadmission testing nurse and may need an in-person visit with a preadmission provider. The scheduler at your surgeon’s office can guide you through this process.
• Health history questionnaire (PDF) this information will be discussed at the time of your phone interview or visit. Feel free to print and complete for easy reference.
• If applicable, please bring your implantable electronic device cards; for example, pacemaker, AICD or spinal stimulator.
• For hip or knee replacement surgery, watch a live or on-demand preoperative class.

• Your surgeon's office will determine whether you need to have lab work and an EKG and will provide you with a lab/EKG request form.
• If you need to come to the hospital for a (PAT) Visit, your visit will include an assessment by a nurse, nurse practitioner and/or physician.
• You will have your lab work and EKG, if applicable, performed at this time.
• If you are unable to keep your preadmission testing appointment, please contact your surgeon's office to have them notify the preadmission testing department.
• The day before your surgery, we will call you between 2:00 pm and 7:00 pm to notify you of your arrival time.

For some surgical or special procedures, you may be required to answer questions that will help us plan for your care. Depending upon factors such as your age, background and medical history, a preadmission evaluation may be performed by a registered nurse.

If preadmission testing is required, we ask that you prepare for your visit by making the following information available:

• All medications that you are taking with the original pharmacy containers- Provide a complete list including all over the counter medications or supplements
• A list of any allergies you have to medication, food, soaps, latex, etc.
• Any recent health problems
• Any chronic medical conditions
• Your use of tobacco, alcohol and drugs
• Any prior surgical and anesthesia procedures
• All letters, test results, consent forms, physical examination reports and any other information from your physician, medical consultant or surgeon
• Any special religious, cultural or personal needs as well as any vision, hearing or reading deficiencies
• Please do not wear any lotions, creams, or oils on the skin to your appointment, as they can interfere with your EKG (electrocardiogram)

Do:

• Bring glasses with a case
• Bring a hearing aid with a case
• Bring a case for your dentures (you will be asked to remove them)
• Bring a CPAP or BiPAP machine if you will be admitted after your surgery
• Notify your surgeon if you develop a cold, cough, fever or other symptoms prior to the date of your surgery
• Wear loose-fitting and comfortable clothing as well as sturdy shoes
• Let us know if you need interpreter services
• Bring remotes for implanted devices

Do not:

• Wear jewelry, including wedding bands and body piercings
• Bring any valuables to the hospital
• Wear makeup, perfume or lotions
• Apply deodorant for breast surgeries
• Shave the surgical site 48 hours prior to surgery

Do:

• Take your medications as directed by your physician
• Take blood pressure, heart, seizure and thyroid medications with a sip of water unless directed otherwise
• Stop taking your weekly GLP1 injection seven days prior to procedure
• Stop taking your SGLT2 medication three days prior to procedure
• If you are prescribed aspirin, blood thinners or anticoagulants, contact your ordering physician for further instructions prior to surgery
• If you are prescribed insulin, contact your endocrinologist or ordering physician for further instructions prior to surgery. If you have an insulin pump, have a copy of the settings and "off-pump" plan available before the day of surgery.
• Bring your inhaler(s), if applicable

Do not:

• Stop any medications unless directed by your physician and/or surgeon
• Take your oral diabetic medications the day of surgery
• Take any diuretics ("water pills") the day of surgery
• Take any of the following medications or supplements 7 days in advance, unless your doctor tells you otherwise:
• Vitamin E
• Vitamins or supplements
• NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen (Advil^®, Motrin^®), naproxen (Aleve^®), diclofenac (Voltaren^®) or celecoxib (Celebrex^®)

• No food or drink 8 hours prior to your ARRIVAL time on the day of the procedure
• In some cases, the surgeon or physician may provide different dietary guidelines to follow

Good hygiene, such as frequent handwashing and daily skin cleansing, promotes good health. Daily skin cleansing helps remove germs that may cause infections. The following instructions should be followed to help reduce germs on your skin prior to your surgical procedure.

• Bactoshield^®/Hibiclens^® CHG 4% is an antiseptic soap. The active ingredient is chlorhexidine gluconate. Do not use this product if you are allergic to chlorhexidine gluconate. This is an over-the-counter product that can be purchased at most retail store or pharmacy.
  • Wash face, hair, and genitals as you normally would then apply minimum amount of CHG 4% wash to your body from neck to toes avoiding genitals, head, and face.
  • Leave on skin for 2 minutes then rinse thoroughly with warm water.
  • Dry with clean towel. Dress in clean clothes
  • Do not apply any products to your skin after this wash. No lotions, creams, powders, or perfumes.
  • Do not use hair removal products or shave at or near the surgical site 48 hours before your procedure (72 hours for cardiac patients)
  • If you are having perineal area surgery (vaginal, rectal or urethral), or no incision is necessary then please use Dial^® Gold antibacterial soap for body. (bar or liquid okay)

You will meet with your anesthesiologist on the day of your surgery. This person will review your medical history and discuss types of anesthesia options that are appropriate for your surgery. This is to ensure your safety and comfort during the procedure. You will be asked to sign a consent form before going to the operating room.

For people with Power of Attorney, you will need to give consent for patients who are unable to do so. Please be available to give informed consent in person or by phone.

The anesthesiologist and your surgeon will determine the best type of anesthesia for you, taking your preferences into consideration whenever possible.

Types of anesthesia:

• Monitored anesthesia care (MAC) – MAC anesthesia provides sedation through an intravenous line (IV) to sedate (calm) you and possibly put you to sleep. It does not cause you to fully lose consciousness.
• General anesthesia – You will be completely unconscious throughout the procedure. A breathing tube may be placed in your mouth to assist with breathing during the procedure.

You WILL NOT be able to drive the first 24 hours after general anesthesia or sedation.

If your surgery does not require an overnight stay in the hospital, you will need someone to take you home; you won’t be able to drive or take public transportation, including Uber, Lyft or a cab, by yourself. If you have not made transportation arrangements, your surgery may be canceled.

When you arrive at your designated time, you may need to report to the surgical registration desk to verify your insurance and pay any co-pays that may apply to you. You will be asked to sign a treatment authorization consent form and a privacy form (HIPAA).

• Bring a copy of your insurance card, a photo ID and credit card/cash/check for your co-pays, if applicable.
• Bring names and phone numbers of your emergency contact(s) and any home care agency you wish to contact, if needed.
• Advance directive: If you are staying overnight after your procedure, you may bring a copy of your advance directive. Learn more about advance directives.
• When you arrive at the preoperative procedure unit, the nursing staff will help you prepare for your surgery. You will be asked to change into a hospital gown and remove items that will interfere with your surgery.
• The nurse will take your vital signs and start an intravenous line (IV) to administer anesthesia and provide hydration.
• Your surgical site may need special preparation. This may involve clipping the hair in the area and/ or scrubbing the area with a special soap.
• During your procedure, your family and friends will wait in the waiting room until they have been notified your procedure is complete. If you would like a designated person to be contacted by the surgeon, please be sure to leave the name and phone number with the nursing staff when you arrive for your procedure.

• When your procedure is over, you will be transported to PACU, where you will recover.
• The PACU nurses, along with the anesthesia staff, will monitor you closely throughout the recovery process.
• The PACU nurses specialize in caring for patients who have just had surgery. They will evaluate your vital signs and comfort level often and will keep your family up to date on your progress. Comfort measures include keeping you warm and keeping your pain tolerable.
• When you have met the criteria for moving to the next stage, you will be transported to your hospital bed if staying overnight, or to stage two of your final recovery process before being discharged from the hospital. Family and friends will be able to join you at this time.
• The PACU is the Post Anesthesia Care Unit — also known as the recovery room. It is a large, open area with patients in various stages of waking. This is a critical care area, and privacy for all patients is paramount. When your loved one arrives in the PACU, the waiting room tracking board will state “In recovery.” We ask that families delay visiting until the patient is transferred to their room. Visitation is allowed in the PACU only in the following situations:
  • Patients who need interpreters or advocates may have one visitor accompany them to the PACU and remain with them throughout their stay
  • Patients who have been fully recovered and are waiting for a bed on an inpatient unit may have one visitor for 10 minutes
  • Pediatric patients

• Once you have met the criteria for discharge, which include stable vital signs, being able to tolerate light refreshments and management of pain, you will start to prepare for your discharge from the hospital.
• At this time, the nursing staff will review the discharge instructions that have been prepared for you by your physician.
• If you had general anesthesia or sedation, you will NOT be permitted to drive for 24 hours after surgery.
• If you had general anesthesia, we strongly recommend that you have someone stay with you the first 24 hours following your surgery. You may continue to be sleepy, and your judgment and reflexes may take time to return to normal. If you are taking opioids for pain, you won't be able to operate a car or dangerous machinery.
• Once you are discharged, any questions or concerns should be directed to your surgeon.

Ask your doctor:

• Are there any prescriptions, over-the-counter medications or herbal remedies that I should NOT take before my surgery? Note: If you are taking weekly GLP1 medications for weight loss or diabetes, these will need stopped 7 days ahead of your procedure. Please reach out to your surgeon’s office or prescribing physician for instruction.
• Can I eat or drink before my surgery?
• Should I trim my nails and remove nail polish or artificial nails?

If you have any other questions, write them down and address them with your doctor.

Ask someone you trust to:

• Take you to and from the surgery facility
• Be with you at the hospital or surgery facility
• Assist with your care and help provide support

Before you leave home:

• (CHG/ Antibacterial Soap) Shower and wash your hair. Do not wear makeup, perfume, powder or body lotion.
• Remove jewelry and piercings and leave them at home. Do not bring valuables or money to the surgery facility.
• Wear comfortable clothing.

• When appropriate, the operable site on your body will be marked by your physician. Not all surgeries are marked. Make sure they mark only the correct part and nowhere else. This helps to avoid mistakes. Collaborate with your surgeon concerning the correct marking of the surgical site.
• Your neck, upper back or lower back will be marked if you are having spine surgery. The surgeon will confirm the exact place on your spine by X-ray.

The staff in the operating room or surgical team (surgeon, anesthesiologist, RN, surgical technician) will conduct a “time-out” to confirm the correct surgery, correct body part and correct side.

The staff in the operating room work as a team to provide the safest possible patient care. They are your advocates while you are having surgery.

The staff will review your Informed Consent form. Read it carefully. It lists:

• Your name
• Your agreement to have the surgery
• The kind of surgery you will have
• The risks of your surgery
• That you talked to your doctor about the surgery and asked questions

Make sure that everything on this form is correct. Make sure all your questions have been answered. If you do not understand something on the form, speak up.

For your safety the staff may ask you the same question many times, for example:

• Who are you?
• What kind of surgery are you having?
• Which part of your body is being operated on?

They will also double-check the records from your doctor’s office.

• Tell your nurse or doctor about any pain or discomfort you are experiencing. Your nurse will ask you to rate your pain on a scale of 1 to 10 so that it can be treated appropriately. It is important to us to help relieve your pain (or help you reach a state of comfort).
• Ask questions about medicines that are given to you, especially new ones. What are they? What are they used for? Are there any side effects? Tell your caregivers about any allergies you have. If you have more questions about a medicine, talk to your doctor or nurse before taking it.
• If you are taking anticoagulant medications, be sure to ask when to resume these medications after surgery.
• Find out about any intravenous (IV) fluids that you are given. These are liquids that drip from a plastic bag into your vein. If you experience any discomfort at the IV site, notify your nurse.
• Ask your doctor when you can resume activities like work, exercise and travel.
• Discharge instructions will be discussed with you prior to leaving the hospital.