Your pre-operative appointments

​

Once you have been identified as requiring a surgical procedure, please make an appointment with your primary care provider to perform a pre-operative work-up to assess your risks and confirm your best possible health prior to exposing you to the stress of a surgery.

*This must be done within 30 days of your surgery and at least 2 days from your surgery to guarantee all appropriate paperwork is received.

​

The standard work-up is as follows:

​

Physicians Office:

• History and Physical 

• Laboratory Studies:

  • CBC with differential (complete blood count)

  • Electrolyte Panel (Na, Cl, K, CO2, BUN, CR and Glucose)

  • Liver Function Tests (LFTs)

  • Urine Analysis

  • Urine Culture

  • PT/PTT/INR (coagulation studies)

  • Others are disease specific

• X-Ray Studies:

  • If you have any pulmonary disease, your doctor may order a Chest X-Ray

• EKG (if over 40 years old or has cardiac history if younger)

• Pulmonary Function Testing (If you have a history of breathing problems)

• Sub-specialist Consults (cardiac, pulmonary, anesthesia, etc. if needed)

 

Change In Health Status

Notify the office if you experience any significant change in your health status: develop a cold, influenza, COVID, a bladder infection, diarrhea, or other infection, before your surgery.

​

Pre-Operative Medication Instructions

​

Unless specifically instructed otherwise by your surgeon or anesthesiologist, please observe the following guidelines for taking your medicines before surgery:

• One Week Prior to Surgery:

  • STOP any GLP-1/GLP-2 agonists including Ozempic, Wegovy, Monjauro, and any generic variant. 

  • STOP any PDE5-Inhibitors including sildenafil [Viagra], tadalafil [Cialis], vardenafil [Levitra], avanafil [Stendra]

  • STOP all aspirin and all aspirin-containing medicines (e.g., Anacin, Excedrin, Pepto-Bismol). Check any cold or pain medication bottles to make certain aspirin is not contained. 

  • STOP all nonsteroidal anti-inflammatory medications (e.g., etodolac [Lodine], fenoprofen [Nalfon], ibuprofen [Advil, Motrin, Nuprin], ketorolac [Toradol], maproxen [Aleve], meclofenarnate [Meclomen], mefenamic acid [Ponstel], naproxen [Anaprox, Naprosyn].

    • It is okay to use Tylenol (normal or extra-strength) or previously prescribed narcotics with Tylenol (i.e. Percocet, Vicodin) for pain control days prior to your procedure, if necessary.

  • ​HERBAL PRODUCTS AND VITAMIN USE SHOULD STOP BEFORE YOUR PROCEDURE: Certain vitamins, minerals, and “herbal medications” can affect anesthetic potency, cause hemodynamic instability, potentiate bleeding, and increase cardiac dysrhythmias. These should be stopped for 7 days prior to your procedure.

  • Ask your primary care provider or cardiologist when to stop any other blood thinners you are on. (e.g., 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) Xarelto (Rivaroxaban))

​

• Day Before Your Surgery:

  • Start the pre-operative Bowel Prep (cleansing procedure) IF appropriate for this surgery (prostate biopsy, aquablation)

    • 2- Fleets Enemas

      • Night before

      • Morning of the surgery

​

• On the Morning of your Surgery:

  • DO NOT TAKE digitalis medicines (e.g., Crystodigin, Digoxin, Lanoxin).

  • DO NOT TAKE oral antidiabetes medicines (e.g., chlorpropamide [Diabinese], glyburide [DiaBeta, Glynase, Micronase], glypizide [Glucotrol], tolazamide [Tolinase], tolbutamide [Orinase].

  • DO 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, with a small sip of water, ALL of your other usual morning doses of regularly prescribed medicines. Use your asthma inhalers and bring them with you to the hospital.

  • If you are staying overnight and have a CPAP machine, please bring it to the hospital. 

​

Pre-Operative Diet Instructions

​

Unless specifically instructed otherwise by your surgeon or anesthesiologist, patients of all ages must observe the following diet restrictions before surgery:

​

1. Eight hours before the Scheduled Start of your Surgery:
   DO NOT EAT any solid foods, including juices with pulp (e.g., orange juice, nectars), lozenges, candy, chewing gum, and mints. DO NOT DRINK full liquid, such as milk, cream, and jello. You may continue to drink up to eight ounces of clear liquids until SIX hours before the scheduled start of your surgery. Clear liquids include Water, clear juices (e.g., apple, grape), black tea and black coffee.

2. Six hours before the Scheduled Start of your Surgery:
   DO NOT TAKE anything by mouth except for your usual medicines; follow the Preoperative medication instructions above.

3. Exceptions:
   DO NOT TAKE anything by mouth for eight hours, except for your usual medicines, if you are pregnant, morbidly obese, or are diagnosed with diabetes, renal failure, or stomach acid reflux with heartburn.

​

Patients undergoing operative or diagnostic procedures involving sedation are required to refrain from eating, drinking or taking anything by mouth for a stated period prior to their surgery or procedure. The reason for this is to prevent complications caused by nausea or vomiting while you are unconscious. Should you vomit while in the unconscious state, the risk exists that the vomit may enter into your lungs causing serious complications such as pneumonia. These complications may result in an extension of your hospitalization following your surgical procedure. It is for this reason patients are often instructed to have nothing by mouth after midnight the night prior to your operation unless otherwise instructed by an anesthetist.

​

Pre-Operative Cleaning Instructions (bathing and showering instructions)

​

Pre-operative showers are to be taken the night before and the morning of surgery just prior to your arrival. All adults are required to take a shower using either a chlorhexidine (Hibiclens) Surgical Scrub antibacterial soap. The reason is to remove as much bacteria from your skin as possible prior to your surgery. If you are allergic to these products please notify your physician or nurse. Perform your shower as follows:

1. Generously lather your body, scrub well, and rinse. Give particular attention to the area were the incision will be made for your procedure.

2. Following the morning shower, do not apply creams, body oils, lotions, perfumes, deodorants, makeup, lipstick, nail polish or any other cosmetic product to the skin or nails.

3. Do not use Hibiclens on your face. You may use any other antibacterial soap for the face.

4. Remove any dark nail polish or acrylic nails at least 2 days prior to your procedure on at least two nails (one on each hand). This is needed to assess nail bed color and monitor oxygen saturation

​

On The Day Of Surgery

​

• You MUST bring your ID and insurance card.

• Wear comfortable, loose-fitting clothes

• Take your medicines as instructed above.

• You may brush your teeth; rinse your mouth, but do not swallow the water.

• 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, please bring a case or container, and solution for contacts, to protect them while you are in surgery.

• Wear a minimum amount of makeup, and no mascara. Please remove the nail polish from both index fingers.

• Please bring a copy of your current medical problem list from you primary care physician (family medicine/internist).

• Optional: bring any advanced directives, healthcare power of attorney, or guardianship papers if you have them.

​

Time To Arrive For Your Surgery

​

You will receive a call from the hospital the day prior to your scheduled surgery date with with the correct time to arrive for check-in prior to your surgery.  This is typically 2 hours prior to your surgery start time.

​

On Arrival

​

Proceed to the surgery location and check in at the information desk to be escorted to the pre-operative registration area.

• You will meet your anesthesiologist to review your medications and discuss the anesthetic most appropriate for your medical condition and procedure prior to surgery.

• Family members/friends may stay with you until you are taken to the operating room.

​

During Surgery:

• Family members/friends waiting for you will be notified at start of surgery, then every 2 hours during surgery, and when surgery is complete. If you desire, the doctor can discuss findings with your family members/friends.

​

After Surgery

After surgery, you will go to recovery to awaken from anesthesia under observation by a nurse in the post anesthesia care unit (PACU). This usually takes 1 hour, occasionally 2 hours. When you have sufficiently recovered from anesthesia, you will either be discharged home or be admitted to the hospital.

​

For outpatient surgeries:

After your surgery you must be escorted/driven home by a responsible adult. You may take a taxi car or shuttle if accompanied by a responsible adult who can stay with you after the driver departs.

​

For overnight observation/inpatient stays:

You will be admitted to hospital for an overnight stay. Dr Su will check on you in the morning and stay in touch with the nurses and hospitalists throughout the day. When you are stable enough to go home, you will be discharged from the hospital. For most patients, this will be in the afternoon on the day after your surgery.

 

When you arrive home, please rest and relax. Let your family members/friends wait on you. Your body will tell you if you are doing too much. Please listen to your body.