Saturday, May 23, 2015

Making elective surgery safer

 We encourage patients to partner with us in optimizing their surgical and postoperative care, starting by asking them to complete a pre-surgery check list as shown below.  

 Here are some steps you can take before your surgery that will increase the quality of the outcome of your procedure. Consider it a ‘pre-flight checklist’. The healthier you are before surgery, the better. Please check off each of these items on this sheet and circle those about which you have questions. Bring the sheet with you to your pre-surgical appointment.

__Engage in three hours of aerobic exercise per week if your primary care physician deems it safe.

__Avoid smoking or use of any nicotine-containing products for three months prior to and after surgery.

__Avoid any narcotic medications stronger than hydrocodone for three months prior to surgery. If heavier narcotics have been used, tapering off under physician supervision should be accomplished three months before the surgery.

__ A plan for patient care after discharge needs to be in place well in advance of surgery, recognizing that your shoulder may be less useful for a period after surgery than it was before. Who will be with you and care for you when you are discharged? How will you get home? Some find that they are more comfortable sleeping in a recliner for several weeks after surgery; you may wish to consider having one available.

__ Discuss with your surgeon the limitations on your activities after surgery, such as restrictions on driving, as well as the need for someone to be with you for days or weeks after the procedure. If a stay in a skilled nursing facility after surgery will be necessary, this should be discussed with your surgeon well in advance of the procedure.

__Identify a primary care physician who can manage non-surgical concerns and medications after surgery.

__Understand and plan for the rehabilitation program after surgery as well as the plan for follow-up with the surgeon.

Physical and emotional health
__Optimize dental hygiene, including gum care. Dental concerns need to be tended to at least 2 weeks before surgery. Postpone any planned elective dental procedures for at least 3 months after surgery.

__Identify any skin lesions anywhere on the body, especially on the arm of the intended surgery. These need to be completely healed at least two weeks before surgery. Be particularly careful to check the skin in the armpit and under the breasts.

__Assure that any infections are completely resolved and antibiotics discontinued at least 6 weeks prior to surgery.

__Optimize control of sleep apnea, anxiety, depression, diabetes, hypertension, heart conditions, as well as urinary tract function.

Communication with the surgical team
__Discuss the surgeon's personal experience with the problem and the procedure along with possible risks, alternatives and anticipated outcomes

__Notify the team if prior experience suggest that it will be difficult to establish an intravenous (IV) line for surgery, if it has been difficult for an anesthesiologist to establish an airway, if you have had any problems with prior anesthetics, or if it has been difficult to control your pain after surgery.

___Let the team know if you or any family member or blood relative ever had a serious problem with anesthesia, and if so, what was the problem?

__Discuss with the surgeon heart conditions, strokes, kidney disease, liver disease, lung disease, bleeding tendencies, prior surgical complications, reactions to anesthetics, seizures.

__Document and communicate all medical allergies, especially allergies to antibiotics and latex.

__Could you be pregnant? If so, we would recommend that you have a pregnancy test performed before coming for surgery, and if you are pregnant, that you not undergo elective surgery until after delivery.

__Compile and share a complete list of all prescription and over-the-counter medications.

__Anti-inflammatory medications and blood thinners (for example, aspirin, Advil, Coumadin, Warfarin, Plavix, Ibuprofen) will increase the risk of bleeding and their use may need to be modified well in advance of surgery. Let your surgeon know if you are taking drugs to prevent blood clotting. These may need to be stopped or modified before and after your procedure. Be aware that many over-the-counter supplements can also increase the risk of bleeding. Please note any supplements on your list of medications.

__Identify and discuss any legal issues regarding the shoulder problem well in advance of surgery.

__Verify your insurance coverage well in advance of surgery. This is especially important for patients living outside of Washington.

Consultation for those who live a distance away from Seattle.

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