Before your surgery

Within 30 days of surgery: your pre-operative work-up

Once you have been told you need a surgical procedure, please make an appointment with your primary care provider for a pre-operative work-up. This visit assesses your risks and confirms you are in your best possible health before the stress of surgery.

The standard work-up is:

• At your doctor’s office: a history and physical exam.
• Lab tests:
  • CBC with differential (complete blood count)
  • Electrolyte panel (Na, Cl, K, CO2, BUN, Cr and glucose)
  • Liver function tests (LFTs)
  • Urinalysis
  • Urine culture
  • PT/PTT/INR (blood clotting tests)
  • Other tests, depending on your condition
• Chest X-ray: your doctor may order one if you have any lung (pulmonary) disease.
• EKG: if you are over 40, or if you are younger and have a history of heart problems.
• Pulmonary function testing: if you have a history of breathing problems.
• Specialist consultations (heart, lung, anesthesia and others), if needed.

If your health changes before surgery

Notify the office if your health changes in any significant way before your surgery, for example if you develop a cold, the flu, COVID, a bladder infection, diarrhea or another infection.

One week before surgery: medicines

Unless specifically instructed otherwise by your surgeon or anesthesiologist, follow these guidelines for your medicines.

• Stop any GLP-1/GLP-2 agonists, including Ozempic, Wegovy, Mounjaro and any generic version.
• Stop any PDE5 inhibitors, including sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra) and avanafil (Stendra).
• Stop all aspirin and all medicines that contain aspirin, such as Anacin, Excedrin and Pepto-Bismol. Check the bottles of any cold or pain medicines to make certain they do not contain aspirin.
• Stop all nonsteroidal anti-inflammatory drugs (NSAIDs), such as etodolac (Lodine), fenoprofen (Nalfon), ibuprofen (Advil, Motrin, Nuprin), ketorolac (Toradol), naproxen (Aleve, Anaprox, Naprosyn), meclofenamate (Meclomen) and mefenamic acid (Ponstel).
• Stop herbal products and vitamins for 7 days before your procedure. Certain vitamins, minerals and herbal medicines can change how strongly anesthesia works, make your blood pressure and circulation unstable, increase bleeding and cause irregular heart rhythms.

For pain, Tylenol is okay

It is okay to use Tylenol (regular or extra-strength), or narcotic pain medicine with Tylenol that was already prescribed to you (such as Percocet or Vicodin), for pain in the days before your procedure if you need it.

Other blood thinners: ask your doctor

Ask your primary care provider or cardiologist when to stop any other blood thinner you take. Examples include Angiomax (bivalirudin), argatroban, Arixtra (fondaparinux), Coumadin (warfarin), Effient (prasugrel), Eliquis (apixaban), Fragmin (dalteparin), heparin, Innohep (tinzaparin), Lovenox (enoxaparin), Plavix (clopidogrel), Pletal (cilostazol), Pradaxa (dabigatran), Refludan (lepirudin), Ticlid (ticlopidine) and Xarelto (rivaroxaban).

At least 2 days before: nail polish and acrylic nails

Remove any dark nail polish or acrylic nails at least 2 days before your procedure, on at least two nails (one on each hand). The team needs to see your nail beds to check their color and monitor your oxygen level.

The day before surgery

Your arrival time

The hospital will call you the day before your scheduled surgery with the correct time to arrive for check-in. This is typically 2 hours before your surgery start time.

Bowel prep, if your surgery needs it

Start the pre-operative bowel prep (cleansing) if it is appropriate for your surgery (prostate biopsy, Aquablation):

• 2 Fleet enemas: the night before, and the morning of the surgery.

Showers: the night before and the morning of surgery

Take a pre-operative shower the night before surgery and again the morning of surgery, just before you arrive. All adults are required to shower with a chlorhexidine (Hibiclens) surgical scrub antibacterial soap, to remove as much bacteria from the skin as possible before surgery. If you are allergic to it, please tell your physician or nurse.

• Lather your body generously, scrub well and rinse. Pay particular attention to the area where the incision will be made for your procedure.
• Do not use Hibiclens on your face. You may use any other antibacterial soap on your face.
• After the morning shower, do not apply creams, body oils, lotions, perfumes, deodorants, makeup, lipstick, nail polish or any other cosmetic product to your skin or nails.

Eating and drinking before surgery

Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must follow these diet restrictions. The times count back from the scheduled start of your surgery.

1. 8 hours before: no food

   Do not eat any solid food. This includes juices with pulp (such as orange juice and nectars), lozenges, candy, chewing gum and mints. Do not drink full liquids, such as milk, cream and gelatin (Jell-O).

   You may keep drinking up to 8 ounces of clear liquids until 6 hours before. Clear liquids are water, clear juices (such as apple or grape), black tea and black coffee.

2. 6 hours before: nothing by mouth

   Do not take anything by mouth except your usual medicines. Follow the medicine instructions on this page.

Why these rules matter

Anyone having surgery or a diagnostic procedure with sedation must go without food, drink and anything else by mouth for a set time beforehand. This prevents problems from nausea or vomiting while you are unconscious. If you vomit while unconscious, the vomit can get into your lungs and cause serious complications such as pneumonia, which can mean a longer stay in the hospital. For this reason, patients are often told to have nothing by mouth after midnight the night before their operation, unless an anesthetist instructs otherwise.

The morning of surgery

Medicines

• Do not take digitalis medicines (such as Crystodigin, digoxin or Lanoxin).
• Do not take oral diabetes medicines, such as chlorpropamide (Diabinese), glyburide (DiaBeta, Glynase, Micronase), glipizide (Glucotrol), tolazamide (Tolinase) or tolbutamide (Orinase).
• Insulin: take one-half of your usual morning insulin dose. Do not take your morning insulin dose if you are driving a great distance the morning of surgery, or if your surgery is scheduled for the afternoon.
• Do take all your other usual morning doses of regularly prescribed medicines, with a small sip of water.
• Use your asthma inhalers, and bring them with you to the hospital.
• If you are staying overnight and have a CPAP machine, bring it to the hospital.

Getting ready

• Take your morning Hibiclens shower, as described above.
• You may brush your teeth and rinse your mouth, but do not swallow the water.
• Wear comfortable, loose-fitting clothes.
• Wear a minimum amount of makeup, and no mascara. Please remove the nail polish from both index fingers.
• Leave all jewelry (including wedding and all other rings) and valuables (including money and credit cards) at home.
• If you wear contact lenses, glasses or hearing aids, bring a case or container for them, and solution for contacts, to protect them while you are in surgery.

What to bring

• Your ID and insurance card. You must bring these.
• A copy of your current medical problem list from your primary care physician (family medicine or internal medicine doctor).
• Your asthma inhalers, and your CPAP machine if you are staying overnight.
• Optional: any advance directive, healthcare power of attorney or guardianship papers, if you have them.

When you arrive

Go to the surgery location and check in at the information desk. You will be taken to the pre-operative registration area.

• You will meet your anesthesiologist, who will review your medicines and talk with you about the anesthesia best suited to your medical condition and your procedure.
• Family members or friends may stay with you until you are taken to the operating room.

During surgery

Family members or friends waiting for you will be told when surgery starts, every 2 hours during surgery, and when surgery is complete. If you wish, Dr. Su can discuss what she found with your family members or friends.

After surgery

You will wake up from anesthesia in the recovery room, the post-anesthesia care unit (PACU), where a nurse watches over you. This usually takes 1 hour, occasionally 2. When you have recovered enough from anesthesia, you will either go home or be admitted to the hospital.

If you go home the same day

A responsible adult must take you home. You may take a taxi or shuttle only if a responsible adult goes with you and can stay with you after the driver leaves.

If you stay overnight

You will be admitted to the hospital for an overnight stay. Dr. Su will check on you in the morning and stays in touch with the nurses and hospitalists (the hospital’s own doctors) throughout the day. You will be discharged when you are stable enough to go home. For most patients, that is the afternoon of the day after surgery.

Once you are home

Rest and relax, and let your family and friends wait on you. Your body will tell you if you are doing too much. Please listen to it.