Preparing for Surgery & Procedure

Preparing for Surgery

Once you and your doctor decide that surgery will help you, you will need to learn what to expect from the surgery and create a treatment plan for the best results afterward. Preparing mentally and physically for surgery is an important step toward a successful result. Understanding the process and your role in it will help you recover more quickly and have fewer problems.

Working with Your Doctor

Before surgery, your doctor will perform a complete physical examination to make sure you don't have any conditions that could interfere with the surgery or the outcomes. Routine tests, such as blood tests and X-rays, are usually performed a week before any major surgery.

Discuss any medications you are taking with your doctor and your family physician to see which ones you should stop taking before surgery
If you smoke, you should stop or cut down to reduce your surgery risks and improve your recovery
Have any tooth, gum, bladder or bowel problems treated before surgery to reduce the risk of infection later **Especially for Join Replacement Surgery**
Eat a well-balanced diet, supplemented by a daily multivitamin with iron
Report any infections to your surgeon. Surgery cannot be performed until all infections have cleared up
Arrange for someone to help out with everyday tasks like cooking, shopping and laundry
Put items that you use often within easy reach before surgery, so you won't have to reach and bend as often
Remove all loose carpets and tape down electrical cords to avoid falls
Make sure you have a stable chair with a firm seat cushion, a firm back and two arms

1. General Pre-Op Instructions

Fasting (NPO):

Nothing to eat or drink after midnight before surgery (unless otherwise instructed for clear liquids up to 2–3 hours prior).
No gum, candy, or mints.

Smoking, Alcohol, Recreational Drugs:

Stop smoking/vaping ideally 4+ weeks before surgery.
No alcohol 24 hours before.
Stop recreational drugs; notify anesthesia if any recent use.

Hygiene:

Shower the night before and morning of surgery with antibacterial soap (e.g., Hibiclens if instructed).
Do not apply lotions, powders, perfumes, or deodorant to surgical site.

Clothing & Jewelry:

Wear loose, comfortable clothing.
Remove nail polish, makeup, jewelry, piercings.

Transportation:

Arrange for a responsible adult to drive you home and stay with you the first 24 hours.

Illness:

Notify the surgical team if you develop fever, cough, sore throat, rash, or infection before surgery.

2. Medications to STOP Before Surgery

Anticoagulants & Antiplatelets

Aspirin: Usually stop 7 days prior.
NSAIDs (ibuprofen, naproxen, diclofenac, meloxicam): Stop 3–7 days prior depending on agent.
Clopidogrel (Plavix), prasugrel (Effient), ticagrelor (Brilinta): Stop 5–7 days prior.
Warfarin: Stop 5 days prior (may need bridging with LMWH).
DOACs (apixaban, rivaroxaban, dabigatran, edoxaban): Stop 2–3 days prior (longer if renal impairment).

Supplements & Herbal Products

Stop at least 7 days before surgery (due to bleeding or anesthesia interaction risk):

Vitamin E
Fish oil / omega-3 fatty acids
Garlic
Ginkgo biloba
Ginseng
St. John’s Wort
Kava, valerian, echinacea, turmeric, ginger (in supplement form)

Other Medications - Special Considerations

ACE inhibitors / ARBs (lisinopril, losartan, etc.): Often held the morning of surgery (risk of low BP with anesthesia).
Diuretics (furosemide, HCTZ): Usually held morning of surgery.
MAO inhibitors: Must be stopped well in advance (consult anesthesia)
Diabetes & Diet-Related Medications aka Weight Loss Drugs **PLEASE READ CAREFULLY** Oral & Non-Insulin Injectables
Metformin: Hold morning of surgery (risk of lactic acidosis if kidney function impaired).
Sulfonylureas (glipizide, glyburide): Hold morning of surgery (risk of hypoglycemia).
SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin): Stop 3 days prior (risk of euglycemic ketoacidosis).
GLP-1 agonists (semaglutide, dulaglutide, liraglutide, exenatide, etc.):
Weekly formulations: Ideally skip dose if within 1-2 weeks of surgery.

3. Medications to Continue

Beta-blockers (metoprolol, atenolol, carvedilol, etc.): Continue to reduce cardiac risk.
Most seizure, thyroid, asthma, reflux meds: Usually continue.
Steroids (prednisone, hydrocortisone, etc.): Continue; anesthesia may give stress-dose coverage.

4. Additional Instructions

Blood Pressure: Take morning BP meds with a sip of water (except ACE/ARB as above).
Inhalers: Bring inhalers the day of surgery and use morning dose.
CPAP: Bring machine if you have sleep apnea

Setting Up for a Smooth Recovery

If you are having day surgery, remember the following:

Have someone available to take you home, you will not be able to drive for at least 24 hours
Do not drink or eat anything in the car on the trip home
The combination of anesthesia, food, and car motion can quite often cause nausea or vomiting. After arriving home, wait until you are hungry before trying to eat. Begin with a light meal and try to avoid greasy food for the first 24 hours
If you had surgery on an extremity (leg, knee, hand or elbow), keep that extremity elevated and use ice as directed. This will help decrease swelling and pain
Take your pain medicine as directed. Begin the pain medicine as you start getting uncomfortable, but before you are in severe pain. If you wait to take your pain medication until the pain is severe, you will have more difficulty in controlling the pain