Topic Overview

Knowing what to expect before, during, and after surgery can help ease your fears. Knowledge can also help you take an active role in your recovery.

Being an active patient means asking questions and not agreeing to anything until you understand it and believe that it's for the best.

Minor surgeries

Minor surgeries that can be done in your doctor's office or at a same-day surgery centre usually take less than 2 hours, and you can recover at home after the surgery. For these, you most likely will need only oral pain medicines after your procedure. Examples of these types of surgeries are:

• Cataract removal.
• Laparoscopy, such as surgery to repair a hernia or remove the gallbladder.
• Breast biopsy.
• Dilation and curettage (D&C).
• Hemorrhoid removal.
• Minor bone or joint procedures, such as arthroscopy or hand surgery.

For more major surgery or emergency surgery, you will probably stay in the hospital.

Before Surgery

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

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

Most surgery centres and hospitals have a before-surgery form for you to fill out. This form usually includes questions about your medical history and current health.

This information helps the surgical team prepare for your surgery. They are trained to provide you with safe care during your surgery. You most likely will complete the form 1 to 3 days before your surgery.

Talking to your surgeon

Talk to your surgeon about what kinds of surgery you have 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 (chronic obstructive pulmonary disease).
• Sleep apnea.
• Asthma.
• Any allergies to foods or any substance, including latex, tape, adhesives, anesthetics, or other medicines. You may also be asked whether 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, influenza (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 natural health products, 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.

Tests before surgery

Before surgery, your surgeon may also ask you to see your regular doctor for an examination and possibly for tests. A surgeon may ask this to make sure that surgery is not 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, such as X-rays or an electrocardiogram (ECG, EKG), if your surgeon thinks they are needed before your surgery.

Your surgeon may 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 have many medical problems, your regular doctor may do your physical examination before surgery. To help make sure that no problems are missed, you may find it helpful to have a doctor who knows you well do this examination and your medical history.

Donating blood

If you will need blood during your surgery, you may wish to donate your own blood. This has to be done several weeks before your surgery.

• Blood Transfusions: Should I Bank Blood Before Surgery?

Talking to a nurse before surgery

Many hospitals or surgery centres have a nurse who will meet with you or call you at home a few days before your surgery. This nurse makes sure all your forms and tests are complete before your scheduled surgery. The nurse also:

• Makes sure the date and time of your surgery are correct.
• Talks about when you should stop eating and drinking before surgery.
• Answers any questions you may have.

Preparing for surgery

Before your surgery, your surgeon or nurse will remind you to do the following:

• Bring any X-rays or other tests that you may have.
• 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 non-steroidal anti-inflammatory medicines (NSAIDs) for 1 week before your surgery.
• Leave all valuables, such as money and jewellery, at home.
• Bring what you will need after surgery, such as your inhaler if you have asthma or a cane if you use one. Also bring your insurance information.
• If you are having same-day surgery, arrange for someone to take you home. And make sure you have someone stay with you for the first 24 hours.
• Shower the morning of surgery, but don't use any perfumes, colognes, or body lotion.
• Remove all nail polish and body jewellery, such as piercings.

Just before surgery

When you arrive for your surgery, your nurse will:

• Check your name, your birth date, and your signed consent for surgery. Your nurse will also check the correct body area for your surgery. If you have any last-minute questions, ask to discuss them with your surgeon.
• Check your vital signs (temperature, heart rate, blood pressure, respiratory rate, and oxygen level).
• Measure or ask about your height and weight.
• Make sure you have not 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. He or she may go over a pain scale, which may be used to help see how you are doing after surgery.

Your surgeon or the surgical team may also give you some information on what will happen after surgery, such as whether you will have special equipment, like another IV, 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.

Pre-surgery medicines

The nurse will give you any medicines ordered by your surgery team, such as:

• Medicines ordered by the anesthesiologist during his or her visit with you before surgery. These medicines will help you relax.
• Antibiotics, if ordered by your surgeon.
• An intravenous (IV) 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.

Family and friends

The nurse will tell your family or friends how long you will be in surgery and in the recovery area. The nurse will also let them know where they can wait during your surgery.

The nurse will answer any questions you or your family members have about your surgery. Tell the nurse who you want to be contacted right after your surgery to talk about how the surgery went.

During Surgery

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

• A surgical technician (scrub), who passes instruments to the surgeon.
• A registered nurse, who helps in many ways and writes the details of your surgery in your medical chart.
• An anesthesiologist, who gives you medicines and monitors 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 they start, the team members will double-check your name, 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 to help you breathe during the surgery. To learn more, see the topic Anesthesia.

Keeping things sterile

The place on your skin where the incision will be is washed with a special solution to remove bacteria. All instruments 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 to decrease 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 will be moved to a hospital room or you will go home. You may receive medicine or fluids through your vein (intravenous, or IV) during your time in the hospital.

After Surgery

If you go home the same day

Relief of any nausea or vomiting is an important concern. If you will be going home the same day, you will need to drink fluids without vomiting, be upright without fainting, and urinate on your own before you will be sent home.

If you go home, the nurse will give you instructions on breathing and exercises to help prevent any problems. For most minor surgeries, the nurse will encourage you to be as active as possible to prevent these problems.

Your doctor may give you medicine for pain.

If you stay in the hospital

Pain control remains an important concern after surgery. Inflammation or nerve injury from the surgery can cause pain. Your doctor may give you more than one medicine for pain. In some cases, you may use a pain pump so that it's easy to get pain medicine right when you need it.

Typically, before you go home your doctors and nurses will make sure that:

• You can breathe using your full lung capacity.
• You are able to eat.
• Your pain has been controlled so that it doesn't interfere with your physical activities.

Risks of surgery

The most common problems after surgery are pneumonia, bleeding, infection, clotted blood (hematoma) at the surgery site, 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.

Anesthesia side effects

Along with putting you to sleep during surgery, anesthesia can have side effects. Two of the most unpleasant ones are nausea and constipation.

While nausea will soon wear off, your constipation can leave you uncomfortable for several days after your surgery. Your nurses can give you a medicine to promote bowel movement. But eating may actually be the most effective means of ending constipation, because food will push waste through your system.

Ready or not?

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

Home care instructions

You will most likely go home with a sheet of instructions including whom to contact if you have a problem.

A nurse will go over these instructions with you. He or she can also help 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, including medicines you take regularly.
• The level of activity that is 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, and what other things you can do as you recover. For most minor surgeries, you will be encouraged to be as active as possible to avoid problems.
• What foods to eat and how your bowel and urinary habits may be different.
• The use of special equipment, such as a sling or crutches.

Incision care

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

• The best way to bathe and protect your wound, such as 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 dressing.
• What clothing to wear to avoid rubbing your incision area.
• What symptoms to look for that may be a problem. Signs of a skin infection, such as a fever, increased pain, or increased drainage, need to be checked by your surgeon. Mild swelling and redness around the incision area is normal after surgery.

Follow-up

Your instructions will include when to have a follow-up appointment with your surgeon. Your surgeon will want to talk to you before your follow-up appointment if:

• You aren't sure about your home-care instructions. Ask right away if you have any questions about wound care or drainage.
• You develop a symptom or problem that you don't know how to handle.
• You develop an unexpected symptom or problem.
• You aren't able to take your medicines.

When should you call your surgeon?

Call 9-1-1 or other emergency services right away if you have these symptoms:

• Signs of shock, such as passing out, or feeling very dizzy, very weak, or less alert
• Moderate to severe difficulty breathing
• Severe pain
• Shortness of breath with a rapid heartbeat. These may be symptoms of pulmonary embolism.
• An increase in leg swelling. This may be a sign of deep vein thrombosis, a condition that can be very serious if not treated.

Your recovery from surgery may be different from what your surgeon expected. Other symptoms or problems may develop after your surgery, even when you follow your surgeon's instructions. This can be very frustrating.

Be sure to call your surgeon if you have an unexpected symptom or problem, including:

• Nausea and vomiting. If you aren't able to keep fluids down, you may become dehydrated.
• Trouble swallowing.
• Pain that doesn't go away after you take your pain medicine.
• A temperature higher than 38.3°C (101°F).
• Trouble urinating or having a bowel movement.
• Loose stitches or an open surgical wound.
• Pus draining from your wound or red streaks.
• A rash.