If you are reading this, and the thought of having an operation is a little daunting, it may be helpful to arm yourself with some useful information. For most folks, the mere idea of undergoing a surgery can be a stressful and confusing time. Many people are still recovering from the surprise that their condition requires an operation, and are unprepared and overwhelmed with the amount of information they are given in anticipation of the procedure. Below is a brief and simplified summary of some of the things you may be told and are expected to understand. Because every surgery is a little different in regard to indications, expectations, risks, and recovery, the guide below should serve as a road map to help you navigate the process.
Most surgeons use the terms preoperative, perioperative, and postoperative to describe the various stages involved, and we will break these down to make understanding them a little easier.
Everything involved in the preparation for a surgical procedure falls under this category. In some instances, this stage is quite brief and often expedited, especially when the operation is done for a more emergent condition. Often a very common, low risk operation does not include all the aspects listed below, but any good surgeon considers these issues.
- Consultation: This is the time when you review your condition with the surgical specialist and formulate a plan. During this phase it is absolutely critical that you speak directly with the doctor doing your operation, review all the options for treatment (including any non surgical ways to manage the condition) and clearly understand what the surgery entails. It is during this discussion you should be fully informed about what risks there are, what is expected from the procedure, and what your recovery will be like. Be sure to ask about and understand in advance the preoperative and postoperative issues discussed below.
- Consent: Most surgeons use a standard consent form to document that you agree to surgery, verify that you understand what will happen, and what the risks are. These risks always include the possibility of bleeding, infection, healing problems and injury to things that are within the operative field. Although hearing some of these risks can be unsettling, it is essential that you are completely informed before agreeing to proceed. This is your opportunity to express any limits to your consent. For example, if your religious beliefs limit the use of blood transfusions, your doctor should acknowledge this fact and modify what you consent to. Likewise, if you place limits on decisions a surgeon may make at the time of the operation, this is the opportunity to clarify these limits.
- Testing: It is often necessary to perform certain tests before an operation to minimize any surprises. These tests may include blood work, x-rays, breathing or heart studies to ensure the doctor is aware of any potential issues that could affect how the surgery goes or how you recover. Even though these things may seem burdensome, remember that the more informed your doctor has before a surgery, the better prepared they are. This preparation may even include evaluation by other specialists to enlist their expertise and provide you the best care possible.
- Preparation: Most surgeries that involve an anesthetic require that you not eat or drink for a period of time (usually 8 hours) before the start of surgery. Having food or liquids in your stomach increases your risk of a complication and, unless it is a true emergency, it’s a sure way to get your surgery canceled. It is ok to brush your teeth and usually ok to take your medication with a sip of water beforehand. Certain medicines that affect blood clotting or suppress your immune system are best held for a period of time before your operation, so always review any medications with your surgeon in advance. You may be asked to perform certain tasks before the operation that could include special antibiotic washes or bowel preparations. Make sure you clearly understand these instructions beforehand. Do not shave at the site of the surgery in advance as it increases your risk of infection.
On the day of your surgery, many things must happen in a coordinated way to ensure everything goes as planned. Be sure you know where to check in and exactly how to get there.
- Check in: Most hospitals expect you to arrive at least 2 hours before the surgery is scheduled to start. This time allows for any final testing and provides an opportunity for the nurses to check you in, verify who you are, what is being done, and if there are any unexpected matters that need to be addressed. Arriving late may result in delays which can translate into moving your surgery back to a later time or even canceling it altogether.
- Holding: Before the operation, you will meet your anesthesiologist, often have your IV placed and you may receive antibiotics. It is not uncommon for many people to ask you the same questions over and over. Remember that this is a safety precaution and in your best interest. Ask your anesthesiologist about options you may have for an anesthetic and what to expect before, during and afterward. Keep in mind the anesthesiologist is not the best person to ask about the specifics of the planned operation. Reserve these final questions for your surgeon, and be sure to mention any new issues that have arisen since your last meeting.
Being aware of what to expect after your surgery is a good way to avoid surprises and alleviate anxiety. It is always better to be familiar with these issues before your surgery so that you are not burdened with remembering instructions or arranging transportation afterward.
- Recovery: Depending on the operation and your anesthetic, you may have little recollection of the time you spend in the recovery room. Rest assured the staff is quite familiar with you, what surgery you had, and what needs to be done. Sleepiness, disorientation and forgetfulness are not uncommon. This is not a time when you will remember everything clearly or be expected to make any important decisions. Rest, recover and let the nurse know if anything is troubling you. They are there to help you.
- Discharge: You should have a pretty good idea whether you are staying in the hospital after your surgery or if you are likely to be discharged. Keep in mind that certainty about this is not always possible until after your surgery. If you are scheduled to go home, there are some basic expectations that need to be met to ensure you will do well at home. Your first dose of discharge medication is often provided to ensure you tolerate it. Voiding before you leave is always a reassurance that there will be no troubles at home. Having a spouse, relative or friend stay with you the first night after an operation is recommended. Avoid making any important decisions, operating machinery, driving or traveling long distances immediately after your operation.
- Recovery: Every operation is different and recovery times vary. Usually progress is “two steps forward, one step back” initially, and being aware of this avoids unrealistic expectations. Your surgeon should have outlined expectations for diet, activity, bathing, and provided instructions about resuming your current medications. It is a good idea to have this information in hand before your surgery.
- Red Flags: Always alert your surgeon for ongoing incision drainage, spreading redness at your incision site, temperatures above 101.5, progressive pain, nausea, vomiting, diarrhea or prolonged constipation. If you are uncertain about something, it is always advisable to ask.
Hopefully, the information above will give you a little more information to work with as you approach an upcoming operation. Having an operation can be a stressful and foreign experience for many people, and having a basic set of guidelines to help you navigate the process will help to lessen some of the uncertainty inherent in the process. Preparation in advance, asking the right questions, and being fully informed go a long way toward making the experience a positive one.