Pre-op care - Getting ready for surgery

Many people undergo surgery every year. Statistics Canada estimates that more than 1.5 million Canadians underwent non-emergency surgery in 2004. Non-emergency surgeries – in other words surgical procedures that are planned and scheduled in advance – usually come after a waiting period. It is useful to take advantage of that time for preoperative preparation.

What is preoperative preparation?

Preoperative preparation can include elements such as scheduling the procedure and organizing for transportation, time off, recovery and rehabilitation programs. The following text will deal more specifically with another aspect of good preoperative preparation: what to eat and how to take your medication. Keep in mind, however, that preparing for surgery will vary based on your specific needs and the type of procedure scheduled. In other words, there are almost as many different types of preparations as there are surgical procedures and patients. The information below may therefore not apply to everyone.

How to take your food and medication is an important aspect of preoperative preparation. It is important to understand that food, medication and certain lifestyle habits (smoking and alcohol consumption, for example) can have an impact on the surgical procedure.

Food

Most surgeries require that patients be fasting, usually as of midnight on the eve of the procedure. Patients may also be advised not to drink alcohol in the 24 to 48 hours preceding certain examinations or operations. In the case of intestine-related procedures, dietary guidelines may be stricter and may require a liquid or low-fibre diet for the 24 to 48 hours preceding the surgery, for example.

A liquid diet, as the name suggests, only permits the intake of liquid foods such as broth, jello, water and pulp-free juice. A low-fibre diet, on the other hand, is a little bit less restrictive since it allows the intake of solid foods. However, foods containing fibre must be avoided, which includes certain grain products, legumes, and most raw or cooked fruit and vegetables.

Medication

It is important that you provide your healthcare team with a complete list of the medication you are taking, including over-the-counter medication and natural products. Depending on your particular case, it may be necessary to temporarily or permanently stop taking some of your medication, and others may be added in preparation for the procedure.

In most cases, it is recommended that patients continue to take their medication as usual in the days preceding the surgery and on the day of the procedure as well. One exception to this rule is diabetes medication. Since taking this type of medication on an empty stomach can cause a serious reaction called hypoglycemia, diabetic individuals must usually abstain from taking their medication the morning of a surgical procedure. They can generally resume taking them as soon as they are allowed to eat again.

The use of certain types of medication may be temporarily suspended ahead of surgery. For example, you may have to stop taking iron supplements prior to procedures involving the intestines, as they could colour the intestinal tissue and complicate the procedure.

Certain types of medication that increase the risk of bleeding, particularly anticoagulants like warfarin and aspirin, may also have to be suspended prior to a procedure. The guidelines for using them perioperatively, however, varies greatly and depends on several factors such as the type of surgery and the patient’s risk of bleeding. Generally speaking, it is recommended that patients stop taking any medication that increases the risk of bleeding three to five days before the operation, and that they resume taking it 24 to 48 hours after the procedure. However, when there is a low risk of bleeding, such as with dermatological or ophthalmic procedures, patients may not have to stop taking their medication. Always check with your healthcare team.

It is also important to remember that some natural products can increase the risk of bleeding, like garlic, ginger, ginseng and ginkgo biloba. In order to reduce the risk of bleeding, patients will probably have to stop taking these products one or two weeks before their surgery. If you take natural products, don’t forget to let your healthcare team know.

Some medication may be added specifically in preparation for surgery in order to facilitate the procedure or reduce the risk of complications. For example, antibiotics are commonly prescribed to prevent a postoperative infection. Patients must usually begin taking them on the morning of the surgery and keep taking them for a few days following the procedure. Laxative preparations are also frequently prescribed in order to “empty” the intestines for gastrointestinal surgery. The agent chosen depends on the type of procedure, the protocol established by the healthcare team, and patient-specific conditions, among other factors. Special care will be taken when choosing this product when it comes to patients with chronic kidney or heart failure, and those who must follow a low-sodium diet.

It is essential that patients conform to the preparation protocol, understanding it fully and following it to the letter. Poor patient preparation could compromise the quality of the procedure or result in having to repeat it. In the wait time preceding a surgical procedure, patients should not hesitate to consult their pharmacist if they have any uncertainties or questions pertaining to taking their medication or the various preparation protocols.

Various behaviours

Certain behaviours could affect how the surgery unfolds. For example, persons with a nicotine or alcohol addiction must understand that they will not be able to consume these products in the period surrounding the surgery. It is therefore imperative to inform your healthcare team of the situation so that proper arrangements can be made (e.g. smokers may be prescribed nicotine patches to help them deal with the withdrawal symptoms related to their forced abstinence).

Lastly, it bears repeating that you must understand and follow your healthcare team’s instructions to the letter in order to maximize your procedure’s odds of success. Preoperative preparation is in fact an essential element of the actual surgery. It even seems that patients recover better after a procedure when they are properly prepared prior to surgery, are given all the necessary information to help them understand what they are experiencing, and show a willingness to get involved in the process. Various studies have shown that proper and thorough patient preparation prior to surgery is associated with reduced complications, a shorter hospital stay and greater patient satisfaction.

It can be intimidating to face surgery, but the members of your healthcare team are there to help you get properly prepared. Follow all their instructions exactly and don’t hesitate to consult them if you have any questions or concerns.