What medications should I stop taking prior to surgery?
You should continue necessary medications to retain a baseline steady state blood level of chronic medications. These include blood pressure, cardiac (heart), epilepsy (seizure), hormone replacement, ulcer, antibiotics, narcotics (pain), and benzodiazepines (anxiety) medicines.
Oral diabetes medication is not taken the day of surgery.
Diet drugs should be discontinued 2 weeks prior to surgery as they may result in rebound blood pressure issues.
Aspirin should be discontinued 10 days prior to surgery. All other anti-inflammatory medications (Motrin, ibuprofen, Aleve, Advil, etc.) should be stopped 7 days prior to surgery to reduce bleeding.
All herbal supplements (not vitamins) should be stopped 1 week prior to surgery.
Rheumatoid medications are as follows: methotrexate and leflunomide continue prior to surgery but hold 1-2 doses after for moderate procedures (most orthopedic cases); sulfasalzaine and hydroxychloroquine can be continued; TNF antagonists should be held 1 week prior to surgery and restarted 10-14 days after surgery, IL-1 antagonists should be held 1-2 days prior to surgery and restarted 10 days after surgery.
What should I eat or drink before surgery?
You should eat a well-balanced meal the evening prior to your surgery. A glass of alcoholic beverage is allowable.
After midnight prior to your surgery, you should not consume any food or beverage. It is ok to brush your teeth and rinse and to take your pre-approved medicines with a sip of water.
ANY other intake may cause your case to be delayed or cancelled.
What do I need for a preoperative workup?
If you are over 45 you will require a pre-operative chest X-ray, an EKG (heart monitor tracing), and a complete blood count lab.
All patients with history of smoking or asthma require a chest X-ray regardless of age.
All females of childbearing age will require a pregnancy test.
Certain procedures require additional laboratory work. For example, total joint replacement requires a chemistry panel, complete blood count, coagulation studies, urine analysis and a type and cross in case blood transfusion is necessary.
Certain health issues require additional work-up and may need to receive clearance from their internal medicine doctor or other specialist depending on the nature of the condition.
What about blood transfusions?
Most orthopedic procedures do NOT require blood transfusion and we employ the most up to date techniques to minimize blood loss. While blood transfusion is relatively safe, we take great effort in attempting to prevent the need for transfusion.
The Paul Gann Act requires that “whenever there is a reasonable possibility, as determined by a physician and surgeon, that a blood transfusion may be necessary as a result of a medical or surgical procedure, the physician and surgeon, by means of a standardized written summary as most recently developed or revised by the State Department of Health Services pursuant to subdivision (e), shall inform the patient of the positive and negative aspects of receiving autologous blood and directed and nondirected homologous blood from volunteers. For purposed of this sections, the term “autologous blood” includes, but is not limited to, predonation, intraoperative autologous transfusion, plasmapheresis, and hemodilution”
If blood transfusion is necessary, the American Red Cross tests for HIV 1 & 2 (viruses that cause AIDS), hepatitis B and C, human T-call lymphotropic viruses 1 & 2 (HTLV), ALT (a liver enzyme) and syphilis. The risk of Hepatitis C is 1 in 103,000 and for HIV it is 1 in 676,000. All others are an even lower risk.
How should I prepare for surgery?
The night prior please shower with Hibiclenz soap (or chlorhexidine gluconate generic solution) which may be obtained at any pharmacy. This reduces the bacterial load you naturally have on your skin and, therefore, decreases your operative infectious risk.
Have the refrigerator stocked with easy to prepare meals and plenty of fluids.
Wear loose comfortable apparel.
Leave all jewelry at home.
Bring contact solution and a case if you wear contacts.
Make your home safe for your return by removing objects that you might trip on (throw rugs, mats, etc.) especially if you are having lower extremity work done.
Allow for plenty of time to arrive at the surgical hospital on time.
If you have the sudden onset of illness (cold, flu, etc.) please notify us as it is unwise to proceed with an elective case in the face of impending illness.
If you are or may be staying overnight, bring reading material, music, and comfortable, loose fitting departure apparel.
What should I bring the day of surgery?
Insurance card/ Workman’s Compensation information
Knee patients: crutches, any brace you have been using
Before being discharged home, we expect your pain to be well controlled. You need to be free of nausea or vomiting, be able to tolerate food, and be able to void (urinate).
You should be aware of your weight bearing status (can you place weight on operative site).
You should be able to demonstrate the appropriate use of crutches if indicated.
Your dressing should be clean and dry.
You should have your pain medications or its prescription in hand.
When appropriate, you should have your “blood thinning” medication (arixtra, lovenox, fragmin, coumadin, or aspirin) to prevent blood clots.
If you are susceptible to constipation, we recommend over the counter colace. Narcotics (pain medicines) tend to cause constipation.
If you are prone to nausea, please request an anti-emetic.
Please ice area for the first day or two. Apply ice 20 minutes on, 20 minutes off as needed. Swelling is very common with orthopedic surgery.
You are encouraged to move your digits (toe or fingers) for most cases. If you are unable to do so without excruciating pain, you should notify us immediately.
Should you have a temperature greater than 101 degrees Fahrenheit, worsening pain, feelings of lethargy, increasing redness or drainage, these may be signs of an infection. Please call us and describe your situation. Most fevers after surgery are not from infection. If you have a low grade temperature (<100.5F) we recommend Tylenol 650 mg every 4 hours but please be aware of your daily acetaminophen consumption. Your narcotic may be listed as 5/500 or some other combination. The second number is acetaminophen. Your total daily intake should not exceed 4000 mg. We also recommend deep breathing exercises after surgery.
What are the risks of surgery?
Please remember, the operating room is a very safe environment. We want to inform you of major complications that may occur, not in an attempt to scare you but so that you may make a fully informed decision. Common risks to any orthopedic surgery are: bleeding, vessel damage, nerve injury (motor and sensory), infection, mal-union (not healing a fracture in the correct alignment), non-union (not healing a fracture), tendon or ligamentous injury, decreased range of motion, pain syndrome, decreased strength or function, wound problems, deep venous thrombosis (blood clots in vessels), pulmonary embolus (blood clots or fat globules sent to the lungs), stroke, pneumonia, cardiac events (heart attack or heart failure), possible loss of limb and death. Occasionally additional surgeries may be required. With most elective procedures in healthy individuals, these risks are very small. Health issues can increase your risks so it is important that you are very forthcoming with all of your health history. Tobacco use, diabetes, immune system disorders and other factors do impair healing and often alter the treatment care process and may even cause your surgeon to choose a different implant device or treatment tailored to your healthcare needs.
Please feel free to ask any questions that we have not addressed. This information is provided not to prevent dialogue between you and your surgeon, but to encourage it.
575 Rivergate Lane, Suite 105 Durango, CO 81301 Phone: 970-259-3020 or 866-737-4739 Fax: 970-259-9766