Surgery: What to Expect

Before Surgery

You will have an appointment with your surgeon before your surgery. Take along a list of questions about the surgery to help you understand your treatment.

Talk to your surgeon about any concerns you have about the surgery. Your surgeon will explain why you need the surgery, what it will involve, what its risks and expected outcomes are, and how long it will take you to recover. You may also want to ask about treatments you might try other than surgery.

Talk to your surgeon about what kinds of surgery you've had in the past. Describe your recovery period, and be sure to mention any problems you may have had.

Describe any health problems you have, such as:

• Diabetes.
• Heart problems. Also tell your doctor if you have a pacemaker.
• Lung problems, such as COPD.
• Sleep apnea.
• Asthma.
• Any allergies to foods or any substance, including latex, tape, adhesives, anesthetics, or other medicines. You may also be asked if any family members have had reactions to anesthetics.
• Any bleeding problems or use of aspirin or some other blood thinner.
• A current—or recent—cold, flu, or fever.

It's important to tell your doctor about any tobacco, alcohol, illegal drugs, or medicines you use. This includes over-the-counter medicines, vitamins, and supplements, such as St. John's wort and diet aids. Your use of substances or medicines may affect your reaction to anesthesia or pain medicines.

Talk about any physical restrictions you have, such as an artificial joint or limited range of motion of your neck, arms, or legs.

Let your doctor know if you have any metal implants or fragments in your body.

Tell your surgeon if you are or might be pregnant.

Most surgery centers and hospitals also have a before-surgery form for you to fill out. This form usually includes questions about your past and current health. This information helps the surgical team prepare for your surgery. You most likely will complete the form 1 to 3 days before your surgery.

Tests before surgery

Before surgery, you may have an exam or tests. These tests are to make sure that surgery isn't likely to be too hard on you. The tests may include:

• Blood tests.
• Urine tests.
• Blood clotting tests.

You may also be scheduled for other tests if your surgeon thinks you need them before your surgery. These may include X-rays or an electrocardiogram (EKG).

Your surgeon may want to include other doctors in your care, depending on your other medical conditions. For example, if you have heart problems, your surgeon may discuss your care with a cardiologist.

If you know before surgery that you might need a blood transfusion during your surgery, you may wish to donate your own blood. This has to be done several weeks before your surgery.

Preparing for surgery

Before your surgery, your surgeon or nurse will remind you to do these things:

• Follow the instructions exactly about when to stop eating and drinking. If your doctor has told you to take medicines on the day of surgery, do so using only a sip of water.
• Do not use aspirin or other nonsteroidal anti-inflammatory medicines (NSAIDs) for 1 week or as instructed before your surgery.
• If you are having same-day surgery, arrange for someone to take you home.
• If you will need it, make plans for someone to stay with you for the first 24 hours.
• Shower before surgery as instructed. Don't use lotions, perfumes, or deodorants.
• Leave all valuables, such as money and jewelry, at home.
• Remove all nail polish and body jewelry, such as piercings.
• Gather these items and bring them with you:
  • Have a picture ID ready to take with you. Your ID will be checked before your surgery.
  • Any X-rays or other test results that you may have.
  • Personal items you'll need after surgery, such as your inhaler if you have asthma, your CPAP machine if you have sleep problems, or a cane or walker if you use one.
  • Your insurance information.

Just before surgery

When you arrive for your surgery, your nurse will:

• Check your name, your birth date, and your signed consent for surgery.
• Check the correct body area for your surgery.
• Check your vital signs. (These are your temperature, heart rate, blood pressure, respiratory rate, and oxygen level).
• Measure or ask about your height and weight.
• Make sure you haven't had anything to eat or drink for the length of time your surgeon told you.
• Check your medical chart for any allergies you have and any medicines you take.

Your nurse will also explain to you what will happen and will reassure you to help you stay calm. The nurse may go over a pain scale. This may be used to help see how you are doing after surgery. If you have any last-minute questions, ask to discuss them with your surgeon.

Your surgeon or the surgical team may also give you some information on what will happen after surgery. You may learn if you'll have special equipment, like a urinary catheter or wound drains.

The nurse will have you:

• Urinate and change into a hospital gown.
• Remove any dental work, such as dentures or plates.
• Remove any hearing or visual aids, such as hearing aids or contact lenses.
• Remove all piercings or jewelry.

Just before surgery, the nurse will give you any medicines ordered by your surgery team, such as:

The nurse may also give you an intravenous (I.V.) line in your arm or hand, if ordered by your surgeon or anesthesiologist. This gives you fluids and medicines before, during, and after your surgery.

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During Surgery

A special surgical team helps the surgeon with your surgery. This team usually includes:

• A surgical technician (scrub). This person passes tools to the surgeon.
• A registered nurse, who helps in many ways. The nurse writes the details of your surgery in your medical chart.
• A nurse anesthetist or anesthesiologist. He or she gives you medicines and watches your vital signs.
• Other medical personnel, such as an X-ray technologist, who may be needed for your surgery.
• Another surgeon to help your primary surgeon, if needed.

In university or teaching hospitals, doctors with different levels of surgical training may watch or help with your surgery. But your surgeon will be in charge.

The surgical team is trained to provide you with safe care during your surgery.

Before the surgical team starts your surgery, the team members will double-check your name. They'll check what type of surgery you are there for and what part of your body is to be operated on.

Anesthesia

If you are having general anesthesia, a breathing tube (endotracheal tube) is placed in your windpipe. Or a special airway (laryngeal mask airway, or LMA) is placed in the back of your throat. These things help you breathe during the surgery.

Keeping things sterile

The place on your skin where the incision will be is washed with a special liquid to remove bacteria. All tools used during your surgery are sterilized to reduce your risk of infection.

Pain control

Pain control is an important concern. Near the end of your surgery, your surgeon may inject a long-acting pain medicine at the site of your surgery. It will ease your pain for 6 to 12 hours after surgery.

In the recovery area

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. A nurse will check your vital signs and bandages. He or she will also ask about your pain level.

When you wake up, you may have a small tube just below your nose that supplies oxygen to your lungs.

You will most likely stay in the recovery area for 1 to 4 hours. Then you'll be moved to a hospital room or you'll go home. You may get medicine or fluids through your vein (intravenous, or I.V.) while you are in the hospital.

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After Surgery

Concerns after surgery

The most common problems right after surgery are pneumonia, bleeding, infection, bruising or blood clotting (hematoma) at the surgery site, trouble urinating, and reactions to the anesthesia.

In the first 48 hours after surgery, the most likely risks are bleeding and problems with your heart or lungs. From 48 hours to 30 days after surgery, the most common risks are infection, blood clots, and problems with other body organs, such as a urinary tract infection.

Another concern is pain control. Inflammation or nerve injury from the surgery can cause pain. Your doctor may give you more than one medicine for pain. Often opioids are given. In some cases, you may use a pain pump so that it's easy to get pain medicine right when you need it.

Anesthesia can have side effects. Two of the most unpleasant ones are nausea and constipation.

Nausea will soon wear off. But constipation can leave you uncomfortable for several days after your surgery. You may get a medicine to help you move your bowels.

Returning home

In most cases, before you can go home after surgery, your doctors and nurses will make sure that:

• Your pain has been controlled so that it doesn't interfere with your physical activities.
• You are able to:
  • Eat.
  • Breathe using your full lung capacity.
  • Drink fluids without vomiting.
  • Be upright without fainting.
  • Urinate on your own.

You may meet most of the criteria to go home, but you may not be able to do certain things well enough to go home. In this case, you may go to a skilled nursing or rehabilitation facility instead of to your home. Nurses and rehabilitation specialists at the facility can help you work toward getting home.

Home care instructions

After surgery, you will most likely go home with a sheet of instructions. You'll learn who to contact if you have a problem.

You may need to arrange for any care you will need when you go home. This may include nursing care or visits from other health care workers.

Your instructions will include:

• Which medicines you are to take and when. These may include medicine for pain and medicines you take regularly.
• Information on breathing and exercises to help prevent any problems. You will be encouraged to get up and move around several times a day. But be careful not to do too much.
• The level of activity that's safe for you to do. For example, the instructions will likely list when it is okay to drive, how much you can walk each day, how much weight you can lift, when you can have sex, and what other things you can do as you recover.
• What foods to eat and how your bowel and urinary habits may change.
• The use of special equipment, such as a sling or crutches.

Your home-care instructions will include how to take care of your incision. They will explain:

• The best way to bathe and protect your wound. For example, the instructions may list how to cover the area if needed and when it is safe to shower and let the incision get wet.
• How to care for and change your surgical bandages.
• What clothes to wear to avoid rubbing your incision.
• What symptoms to look for that may be a problem. Signs of a skin infection, such as a fever, more pain, or more drainage, need to be checked by your surgeon. Mild swelling and redness around the incision area is normal after surgery.

When to call for help during self-care

Call a doctor if any of the following occur during self-care at home:

• New or worse trouble breathing.
• New or worse chest pain, shortness of breath, or coughing up blood.
• New or worse pain or swelling in your leg.
• New or worse bleeding.
• New fever.
• New or worse nausea or vomiting.
• New urinary problems.
• New or worse signs of infection in the surgical area, such as redness, warmth, swelling, or pus.
• Symptoms occur more often or are more severe.

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