Preparing for Surgery

When does it all start?

Once you have booked your operation, two things are required: a complete physical exam and a pre-admission appointment. Some surgeons will do the physical exam themselves; others will ask you to have your general practitioner do it. Depending on the nature of your surgery, you may need to have a complete blood count done. Your surgery and medical condition may also necessitate additional tests.

Different hospitals, and even different surgeons within a hospital, will differ in how they book pre-admission appointments. Some will set everything up for you; others will leave the initiative to you. Ideally, you should have your pre-admission appointment at least three weeks (but not more than a month) before surgery, especially if you’re planning to take advantage of some of the therapies that reduce the need for blood transfusion during surgery.

Your Pre-admission Appointment

What you will do

A pre-admission appointment involves several things, and it may take up to six hours. Ask how long it will likely take when you’re booking it, but expect to set aside an entire day. In your pre-admission appointment,

*you’ll have your blood counts done if they weren’t done as part of your physical exam;

*if you’re over 35, you may need to have an electrocardiogram (ECG) and chest x-ray done; depending on the type of surgery, you may need to have other x-rays done as well;

*if you’ve had certain kinds of health problems (such as heart problems, high blood pressure, or diabetes), you may be asked to see an anesthesiologist;

*you’ll receive information about your surgery and what to do before and after it; this may include pamphlets, classes and videotapes. The more extensive your surgery, the more time will be spent on this;

*you’ll undergo any other necessary preparations;

*and you’ll speak with a pre-admission nurse about your options for dealing with blood loss. The nurse will usually have seen your blood counts and will be able to advise you on what alternative is best for you.

Dealing with Blood Loss

The three main ways of dealing with blood loss are

* replacing by transfusion. See our article on "Managing Blood Loss" for more information on this. Although the risks associated with receiving donated blood are quite low, many people prefer to donate their own blood in advance. This is called autologous blood donation. If you are anemic, you may need to increase your red blood cell count through iron supplements and possibly through erythropoietin, a drug that helps you to make more red blood cells.

* recycling and conserving. Blood can be conserved through minimally invasive surgery and can be recycled through blood conservation during surgery. Acute normovolemic hemodilution (ANH) is a new technique that both recycles and conserves. It involves removing some of your blood during surgery and replacing it with fluids. After surgery, the blood is put back into your system. In this way, fewer red blood cells are lost during surgery. It’s an increasingly popular procedure, but it’s not available everywhere, and it’s not suitable for all surgical procedures or for patients whose bodies can’t deal with the excess fluids (such as those with a history of coronary artery disease or congestive heart failure). As well, you need to have a sufficient red blood cell count.

* reproducing — in other words, making more blood. Blood production is encouraged with iron supplements and, possibly, erythropoietin. Any patient who is anemic should be on iron, and many will benefit from erythropoietin. As well, some patients may need to do this in addition to one or more of the above methods.

Scheduling is important if you wish to take advantage of these therapies. For example, if you’re considering an autologous blood donation, you can’t donate blood less than 72 hours before surgery, and you can’t make blood donations less than seven days apart. If you’re donating two units, this means you need two appointments, the first of which — normally done during your pre-admission appointment — must be at least two weeks before your surgery. You should start taking iron supplements as soon as you know you’ll be making an autologous donation. On the day of the donation, have a good breakfast and plenty of fluids.

You can find out more about your blood options with our video, "Ready When You Are: Planning for blood loss in surgery," available for online viewing with Real Player. And you can find out more about anemia and red blood cell levels in our article "Understanding Blood Counts and Hemoglobin."

Before Your Surgery

Until recently, patients were usually admitted to the hospital the night before surgery and received much of their training and information then. Now the training is done during the pre-admission appointment, and patients normally arrive at the hospital on the morning of their surgery.

What to do the day before

You will have been advised what medications, if any, to take in the days before surgery. Beyond those, don’t take any medication or drink any alcohol within 24 hours of surgery. As well,

*don’t eat any solid food after midnight, not even chewing gum or candy;

*don’tsmoke or drink even clear liquids less than five hours before your surgery (if possible, don’t drink anything after midnight; that way, if there is a cancellation ahead of you, you’ll be able to have your operation in the earlier time slot);

*don’twearnail polish, makeup, contact lenses, or jewelry on the day of the operation.

The night before your surgery, you should have a light supper and avoid fried foods. After supper, take the time to set out or pack all the things you’ll need, including

*your health card and other necessary identification;

*loose, comfortable clothing — no more than you need;

* necessary toiletries and facial tissues;

*a small amount of cash for buying snacks, magazines, etc.; leave all other valuables and money at home (if you need to bring more, it can be kept safe for you by the hospital);

*and a book or magazine to read.

You may also want to bring a long-distance calling card, as phone calls are not covered and cell phones are prohibited. You can have your family or friends bring you other small items, such as a radio, after the operation. Check to confirm what’s allowed in the hospital.

What you will do on the day of surgery

Most hospitals will ask you to arrive two hours before surgery. Don’t be late, or your appointment may be cancelled. You will be checked in and given an identification band. You’ll change into a hospital gown and slippers, and a nurse will check your physical state. Right before you are taken into the operating room, your anesthesiologist will go over some details with you. When your appointment time comes, you’ll most likely walk in, while any family or friends will be taken to a waiting room. After surgery, you’ll spend an hour or so in a recovery room — usually half the time the operation took — and will then be transferred to a ward.

What you’ll do following the operation will depend entirely on the operation and your state of health. But you will have been prepared for it with the necessary training and facts during your pre-admission appointment.