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P L A S T I C   S U R G E O N

Preparing for surgery? What you need to know

Before you are admitted to hospital for a surgery, there are things to do to ensure you are ready for your operation.

A month before your surgery

Dr Teh’s staff will have arranged for your admission to hospital and will let you know your admission date. They will also tell you if there is any pre-admission preparation you may require, such as blood and other diagnostic tests(ie xrays/CT scans) and medications to be stopped. If it is safe to do so, most procedures are best undertaken after adequate cessation of antiplatelet (ie aspirin, clopidogrel, prasugrel or ticagrelor) and/or anticoagulants (ie heparin, warfarin, dabigitran, apixaban, rivoraxaban and edoxaban). Do check with your GP or specialist before stopping these medications. They can usually be restarted the day after surgery provided there hasn’t been any significant postoperative bleeding. There are some natural medicines that thin blood and these should be stopped (turmeric, cayenne peppers, ginger, garlic, vitamin E, chinese cassia cinnamon, gingko biloba, ginseng, St Johns wort, bromerlain and grape seed extract).

You will need to complete the pre-admission form provided and send it to the hospital at least seven days prior to your admission date.

You may be contacted by your designated anaesthetist about your admission or if further tests are required. This can be done on the phone or in person at the hospital.

If a pre-admission hospital appointment is needed a pre-admission nurse will complete a pre-operative check which may include blood tests or other scans. You will also be assessed to see if you may need any further help after discharge.

Importantly, this is also an opportunity for you to ask any questions you may have about your surgery. I suggest you write down your questions so you don’t forget to ask everything on your mind. For more complex or cosmetic cases, Dr Teh will normally arrange for you to be seen again just prior to surgery to complete the consent process and to have preoperative photographs taken.

Be aware that for safety reasons, hospitals have varying BMI weight limits and your admission may be cancelled should you exceed this limit.

Important note for people who smoke

If you smoke, now is the time to give up or at least reduce the amount of cigarettes you smoke. Smoking can increase your risk of complications during and after surgery. Furthermore, if you don’t stop smoking before your surgery you are more likely to have:

  • Wound related problems such as wound breakdown or tissue necrosis, infection and swelling (seroma) – all leading to delayed healing
  • Lung related issues like lung collapse(atelactasis), poor oxygenation(hypoxia) and pneumonia
  • As a consequence of the above, you will have a longer stay in hospital

To reverse the effects of smoking, you should ideally stop smoking 6 weeks prior to surgery where possible. Dr Teh will usually not undertake complex elective or cosmetic surgery if you continue to smoke due to the higher risk of a suboptimal outcome.

One week before your surgery

You may be required to see Dr Teh during this time to complete your presurgical checks. You may be required to have some blood tests and do follow any special instructions, in particular if you need to stop any medication such as blood thinners.

Some of the painkillers you will get after your surgery will cause constipation. It is a good idea to ensure that your bowels are regular prior to your surgery to avoid problems during your stay in hospital.

If you have had problems with Staph skin infections in the past, do inform Dr Teh of this and he may consider a decolonising treatment for your skin a week prior to your surgery.

One day before your surgery

A hospital caregiver will contact you in the afternoon of the business day before your surgery with information about your admission and fasting times and pre-surgery instructions. You will need to fast if you are booked for a general anaesthesia or twilight/sedation procedure. You do not need to fast for a local anaesthetic operation.

If you are having major surgery or if you have had a history of blood clots, you may be required to self administer an injection of a blood thinner the night prior to surgery to reduce the risk of blood clots following your surgery. Dr Teh will write you a script for this injection if you are required to have the injection.

It is not recommended that you drive home after surgery, so it is good to make sure you have your travel arrangements finalised at this time. This could mean a quick call or SMS to your family member or friend to confirm that they can drop you off or pick you up.

If you are undergoing a day procedure, you must arrange for a responsible adult to drive you home and stay with you overnight.

The day of surgery

Your approximate surgical time will be confirmed by a hospital caregiver during your pre-admission phone call the day prior. For general anaesthesia and sedation/twilight patients, you should fast for 6 hours prior to that time. Please note that lollies and chewing gum are considered food. It is safe to have small sips of clear fluids up to 2 hours prior to your surgery. Clear fluids pass through the stomach faster than food. A clear fluid is a fluid you can see through. It must not contain food, fibre or fat. Milk or formula is not a clear fluid. An example of a clear fluid is water, clear apple juice or other clear fruit drinks, black tea lemonade and cordial.

Unless otherwise instructed, continue to take prescribed medications.

Shower at home and do not apply any powders, deodorants or other cosmetics.  Shave around the area of the surgery. This will help with applying dressings to the wound after the surgery. If you are having an abdominoplasty or DIEP flap procedure, you will need to shave your pubic area.

Ensure any gel, acrylic nails and nail polish is removed from your fingers and toes.

What to bring

Read your hospital’s admissions information to find out all the details about what to bring to hospital. Importantly, we strongly recommend you leave valuables such as electronic items, jewellery (wedding rings can be taped) and large amounts of cash at home. Keep only small amounts of cash for newspapers or other items.

If you have any questions about your upcoming surgery contact Dr Teh’s office or phone the hospital pre-admission department.

adapted and modified from the preadmission guidelines of St John of God healthcare