Your guide before your operation

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What is this information about?

This information is about:

• why you will have a pre-operative assessment: an appointment to check your fitness for your surgery and what pre-assessment involves
• how you can get as fit and healthy as you are able before your operation so that your operation and recovery go as well as possible
• what you need to do to get ready for your operation, including what you should bring into hospital
• what you should eat and drink in the hours before your operation
• what you can do to reduce the chance of getting a blood clot (DVT) after your operation.

Why have I been given this information?

You have been given this information because you are due to have an operation. It will help you to understand what you should do to be ready for your operation and what will happen on the day of your operation.

If you follow the advice in this information, you have a better chance of your operation and recovery going well.

What will happen in my pre-operative assessment clinic appointment?

So that we can check how well you are and make sure that it is safe for you to have your operation:

• we will measure your weight, height, and blood pressure
• you may also have:
  • an ECG to record the rhythm of your heart
  • a swab to test for bacteria MRSA. This helps to prevent the spread of the bacteria and lowers the chance of you getting complications because of it whilst you are recovering
  • blood tests
• we will talk with you to find out any health conditions you have now or have had before
• we take a note of what medications you are taking and if you are allergic to any medications
• we will talk with you about whether you have ever had any problems caused by having an anaesthetic (medication to numb the site or put you to sleep while you have an operation so that you do not feel pain)
• we will talk with you about managing any health conditions you have so that as far as possible they do not get worse because you are having your operation
• we will advise you if there are areas that need further treatment or investigation to ensure good recovery
• we will advise you what you must do about taking or stopping your medications before your operation
• we will tell you what you can eat or drink in the hours before your operation (give you instructions for fasting).

Is it important to keep myself fit and healthy before my operation?

Yes. Keeping fit and healthy gives you have the best possible chance of your operation recovery going well and of avoiding complications.

What can I do to keep myself fit and healthy between now and when I have my operation?

The most important things you can do are:

• be active and get exercise
• eat a healthy balanced diet
• be mentally ready for your operation. For example, find ways to cope with stress and worries
• if you smoke, stop as soon as you can. Ask your GP for advice on things which can help you to do this.

If you would like further information on these and other ways to get ready for your operation visit: Royal College of Anaesthetists.

Fasting rules

What fasting rules should I follow in the hours before my operation (what can I eat or drink)?

If your operation is in the morning:

• Do not eat anything after midnight. This includes solid foods, milky drinks, sweets, chewing gum, fizzy drinks, and alcohol.
• Do drink plenty of clear fluids until 6.30am. After this time, you can continue to have sips of still water until the time you are taken to theatre (up to a maximum of 170mls per hour) unless your anaesthetist advises otherwise.

If your operation is in the afternoon:

• Do eat a light breakfast before 7.30am if you feel like it.
• Do not eat anything after 7.30am. This includes solid foods, milky drinks, sweets, chewing gum, fizzy drinks, and alcohol.
• Do drink plenty of clear fluids until 11.30am. After this time, you can continue to have sips of still water until the time you are taken to theatre (up to a maximum of 170mls per hour) unless your anaesthetist advises otherwise.

Your medication

What do I need to do about the medication that I am taking?

Your medication. Pre-op assessment staff will complete this section for you.

Please see the table in the PDF version of this leaflet.

What happens if I am taking anticoagulant (blood thinning) medications such as warfarin?

Some anticoagulant medications must be stopped before you have an operation as they can make you bleed a lot or cause complications.

If you need to be referred to the anticoagulant clinic, you will be told at your appointment and the Pre-op Assessment Team will refer you. You will be given an anticoagulant plan before your operation.

If you have been referred to the anticoagulant clinic, do call them as soon you know the date of your operation:

Worthing clinic: phone 01903 285211

St. Richard’s clinic: phone 01243 788122

Princess Royal Hospital patients will receive their anticoagulation plan at the pre-op meeting.

What to do and do not on the day of your surgery

What things can I do, and not do, on the day of my operation?

Reducing the chance that you will get a blood clot

Is there a chance that I may get a blood clot after I have had my operation?

Yes. Having an operation can increase your chance of having a blood clot.

When you are in hospital and unwell, or are recovering afterwards, you may spend more time than usual in bed or sitting in a chair. When you are not moving around much blood clots can form more easily.

Other things which mean you have more chance of getting a blood clot include:

• being over 60 years of age
• being very overweight (obese)
• having cancer

What types of blood clot might I get and why is it important to try and prevent them?

A blood clot is a thick clump of blood. It stops your blood from flowing properly as it causes a blockage.

If the blockage is in a vein deep in your body, it is called a deep vein thrombosis (DVT). Most DVTs happen in the legs. A DVT can cause pain, swelling and redness. Sometimes they do not cause any symptoms at all.

A clot can also move to the lungs. This is called a pulmonary embolism (PE). A PE can make it difficult to breathe and cause chest pains.

In a small number of people, it can even cause death so it is important that we, and you, do everything we can to make sure you do not get a DVT or PE.

What can I do to lower the chance of getting a DVT or PE?

• Before your operation:
  • keep to a healthy weight
  • do regular exercise
  • stop smoking
• After your operation:
  • get out of bed as soon as you can
  • keep moving or walking as much as possible
  • drink plenty. Your blood becomes thicker and more likely to clot if you do not drink enough.
  • do regular foot and leg exercises. Do not cross your feet or legs.
  • wear the special compression stockings (anti-embolism stockings) that we will give you.
    • make sure they fit without causing pain. Tell us if they are hurting
    • you may need to keep wearing your stockings until you are back to your usual level of activity
    • make sure they are taken off daily so that your feet can be cleaned, and that they are put back on afterwards
    • make sure that you follow the instructions for wearing your stockings that you will be given before you leave hospital.

If you need them, we will prescribe you medications that thin your blood to help stop you getting clots.

We will give you separate information about blood clots and how to avoid them. Please read the separate leaflet given or emailed to you from pre-op assessment clinic.

Contacting the Pre-Op Assessment Clinic

When must I contact the Pre-op Assessment Clinic?

Do contact us in Surgical Pre-op Assessment Clinic if:

• there are any changes to the medications you are taking. For example, if they are stopped or the dose changes
• you start taking any new medications
• there are any changes to your state of health or if you become unwell or have to come in to hospital for treatment
• if you get diarrhoea or are being sick (vomiting) in the 72 hours (three days) before you are due to have your operation.

What are the contact details for the Pre-Op Assessment Clinics?

Can I contact the Pre-op Assessment clinics to book my operation date or any appointments?

Prehabilitation

What is prehabilitation and how can it help me?

Prehabilitation means making changes to your lifestyle before your operation which will improve your health.

These changes can help your operation to go better and help you to recover more quickly. They can also improve your health and quality of life in the longer term if you stick with them.

Do start making changes now.

Which lifestyle changes should I start making now?

So that you are as fit as possible before your operation and into the future try make these lifestyle changes now:

Smoking. (If you smoke, stop).

Smoking is one of the biggest causes of problems around the time of an operation.

We know that stopping smoking can be hard, but it is important. Create a plan that works for you. You can get help and advice on quitting smoking from:

• your GP
• a local helpline on 01273 267397
• the internet: NHS Better Health

   The good news is that stopping smoking can:

• help your blood pressure
• improve your lung function (make it easier for you to breathe and to not get out of breath)
• lower the chance that you will get heart disease or have a stroke
• mean that you have a shorter stay in hospital after your operation
• improve how your wound heals after your operation and your recovery

Alcohol

Alcohol can have many effects on the body. Importantly it can make the liver less able to make the building blocks your body needs to recover. If you drink regularly, it is advisable to start cutting your intake down and drinking less than 14 units per week.

You can find tips on cutting down on the NHS website Tips on cutting down – NHS (www.nhs.uk)

Diet

Try to eat a heathy diet and drink plenty of water. Your body needs this before your operation so that you are getting the right nutrition. Keep to a healthy diet after your operation so that your body has the nutrition it needs to repair itself.

Exercise

Take regular exercise to improve your fitness. This will prepare your body for the strain which having an operation puts it under and help you to recover.

Try to do any activity which makes you feel out of breath for at least 30 minutes, five times a week, for example walking, swimming, or cycling.

If you are new to exercise, then start slowly and stay within your limits. As your fitness improves you can do more exercise.

Weight

If you are overweight, losing weight can help reduce the stress on your heart and lungs and reduce complications such as blood clots and wound infections.

My health before my operation

Is it important to control any medical conditions that I already have as well as possible before I have my operation?

Yes, it is important to control any medical conditions as well as possible before surgery. These include:

Diabetes

Controlling your blood sugars is important to reduce the chance of you getting an infection after your operation.

Blood pressure

Controlling this to safe levels less than 160 over 90 will reduce the chance of you having a stroke. Your operation may be delayed if your blood pressure is too high.

Anaemia

If you think you might be anaemic talk to your GP about getting a test. Symptoms of anaemia include tiredness and lack of energy (lethargy), shortness of breath, noticeable heartbeats (heart palpitations) and a pale complexion. Early treatment can make you feel less tired and give you more energy. It can also mean that:

• you do not need to have a blood or iron transfusion
• you heal and recover better after your operation

Heart, lung, or other medical problems

Do ask your GP or Nurse to review your medications if this has not been done recently so that they can make sure you are on the best medications and dose for you. You can also book in for a general health check at your GP surgery if you are between 40 and 74 years old.

Anxiety and mental health

It is usual to be anxious about having surgery. Relaxation, mindfulness, and breathing exercises can all help. Your GP surgery can tell you about local support that is available.

Dental health

If you have loose teeth, crowns, or bridge these can be damaged during an operation. Visit your dentist to have them repaired before your operation if you can.

Poor dental hygiene can increase the chance of getting an infection after an operation. Getting any dental work you need done and having your teeth and gums cleaned at the dentist can help to prevent this.

Getting ready for the day of your operation, your hospital stay, and going home afterwards

What should I do before I come into hospital for my operation?

Before you come into hospital for your operation:

• Do have a bath or shower on the day of your operation before you come into hospital. This will reduce the chance of you getting a wound infection.
• Make plans. You may be very tired after your operation. If you make plans before you come into hospital you will be able to rest and heal better when you are at home and avoid stress and worry.
  • talk to your family, friends, and neighbours about coming to hospital. They can all support you and help you prepare for coming home.
  • make sure you have enough easy to cook, healthy meals and snacks ready for when you are back at home.
  • plan who will look after your children, pets, or anyone you usually look after when you are in hospital and when you are recovering at home.
  • make sure that you have some pain-killing medication such as paracetamol and ibuprofen at home for pain relief after your operation.

What should I do when I am back at home after my operation?

Remember that although you may need help with things such as shopping, cooking, getting dressed and washing after your operation it is important to keep active in the ways that you can. For example, try to have a walk if you are able.

Do keep up with any positive lifestyle changes that you started so that you could get fit after your operation.

How soon can I drive after my operation?

Your nurse will talk to you about driving when you have your pre-op assessment.

Is there any other information that I should read?

We may give you some other leaflets which are about the operation you are having or other things to do with your health. Please keep these safe and read them before you come into hospital for your operation. 

Who should I contact if I would like any further information or need support after I have read this information?

Please contact your Pre-op Assessment Team using the contact details earlier in this information.