Surgery: What to Expect

Topic Overview

Surgery is done for many reasons. Often it is done to repair an injury, such as a broken bone, or to relieve symptoms, such as numbness caused by a herniated disc. Sometimes it is done to diagnose a condition (biopsy) or to cure a condition, such as appendicitis.

Many minor surgeries can be done in your doctor's office or at a same-day surgery center. Preparing for minor surgery may take only a few hours. Major surgery is usually done in a hospital operating room. Except in an emergency, major surgery may require days or even weeks of testing and preparation.

Before surgery, your surgeon may ask you to see your regular doctor for an exam and possibly tests. A surgeon may ask this to make sure that surgery is not likely to be too hard on you.

You will also have an appointment with your surgeon before your surgery. For this appointment, take along a surgery question form (What is a PDF document?) to help you understand your treatment. Your surgeon will explain why your surgery is needed, what it will involve, what its risks and expected outcome are, and how long it will take you to recover. Talk to your surgeon about any concerns you have about the surgery. You may also want to ask about treatments you might try other than surgery.

Your surgeon or a nurse will give you a list of instructions to help you prepare for your surgery. Most surgery centers and hospitals have a before-surgery (preoperative) form and a surgery consent for you to fill out. You may also need to sign a form that identifies the correct body area for surgery. This information helps the surgical team prepare for your surgery.

After surgery, you will be taken to a recovery (postoperative) area where nurses will care for and observe you for 1 to 4 hours. Then you will either be moved to a hospital room or go home. If you go home, the recovery nurse usually gives you written instructions to follow. Your surgeon may also give you special instructions.

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Before Surgery

Preoperative care

Most surgery centers and hospitals have a before-surgery (preoperative) form for you to fill out. This information helps the surgical team prepare for your surgery. They are trained to provide you with safe care during your surgery. This form usually includes questions about your medical history and current health.

• Talk to your surgeon about what kinds of surgery you have had. Describe your recovery period, and be sure to mention any problems you may have had.
• Describe any health conditions you have, such as:
  • Diabetes.
  • Heart problems. Also tell your doctor if you have a pacemaker.
  • Lung problems, such as COPD (chronic obstructive pulmonary disease).
  • Sleep apnea.
  • Asthma.
  • Any allergies to foods or any substance, including latex, tape, adhesives, anesthetics, or medicines. You may also be asked whether any family members have had reactions to anesthetics.
  • Any bleeding problems or use of blood-thinning medicine, such as warfarin (Coumadin, for example), clopidogrel (Plavix), or aspirin.
• Tell your surgeon if you currently have a cold, flu, or fever or have had one recently.
• It is important for you to be honest with your doctor and tell him or her about any tobacco, alcohol, illegal drugs, or medicines you use. This includes herbal supplements, such as St. John's wort. Your use of substances or medicines may affect your reaction to anesthesia or pain medicines.
• Talk about any physical restrictions you have, such as an artificial joint or limited range of motion of your neck, arms, or legs.
• Let your doctor know if you have any metal implants or fragments in your body.

It is also important for your surgeon to know whether you are or might be pregnant.

You most likely will complete the preoperative form 1 to 3 days before your surgery. Your regular doctor or your surgeon may order certain tests—such as blood tests, urine tests, and blood clotting tests—to help determine your overall health. You may also be scheduled for other tests, such as X-rays or an electrocardiogram (EKG), if your surgeon thinks they are needed before your surgery.

Your surgeon may include other doctors in your care, depending on your other medical conditions. For example, if you have heart problems, your surgeon may discuss your care with a cardiologist. If you have many medical problems, your regular doctor may do your physical exam before surgery. To help make sure that no problems are missed, it can be helpful to have a doctor who knows you well do this exam and your medical history.

If you will need blood during your surgery, you may wish to donate your own blood. This is called autologous donation. It will have to be arranged several weeks before your surgery. To qualify for autologous donation, you must not be anemic.

Should I bank blood before surgery?

Many hospitals or surgery centers have a nurse who will meet with you or call you at home a few days before your surgery. This nurse makes sure all your forms and tests are complete before your scheduled surgery. The nurse also:

• Makes sure the date and time of your surgery are correct.
• Talks about when you should stop eating and drinking before surgery.
• Answers any questions you may have.

Minor surgeries that can be done in your doctor's office or at a same-day surgery center usually take less than 2 hours, and you can recover at home after the surgery. For these, you most likely will need only oral pain medicines after your procedure. Examples of these types of surgeries are:

• Cataract removal.
• Laparoscopy. Many laparoscopic procedures are same-day surgeries, such as surgery to repair a hernia or remove the gallbladder.
• Breast biopsy.
• Dilation and curettage (D&C).
• Hemorrhoid removal (hemorrhoidectomy).
• Minor bone or joint procedures, such as arthroscopy or hand surgery.

For more major surgery or emergency surgery, you will probably stay in the hospital.

Before your surgery, your surgeon or nurse will remind you to do the following:

• Bring any X-rays or other tests that you may have.
• Do not eat or drink anything for a certain length of time before your surgery. The amount of time depends on your surgery, the type of anesthesia that will be used, your age, and any medicines you take regularly. In most cases, you will not be able to eat or drink for 6 hours before your surgery.
• Do not use aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) for 1 week before your surgery.
• Leave all valuables, such as money and jewelry, at home.
• Bring what you will need after surgery, such as your inhaler if you have asthma or a cane if you use one. Also bring your insurance information.
• If you are having same-day surgery, arrange for someone to take you home. And make sure you have someone stay with you for the first 24 hours.
• Shower the morning of surgery, but do not use any perfumes, colognes, or body lotion.
• Remove all nail polish and body jewelry, such as piercings.

In the preoperative area

When you arrive for your surgery, your nurse will:

• Check your name, your birth date, and your signed consent for surgery. Your nurse will also check the correct body area for your surgery. If you have any last-minute questions, ask to discuss them with your surgeon.
• Measure your vital signs (temperature, heart rate, blood pressure, respiratory rate, and oxygen level).
• Measure or ask about your height and weight.
• Make sure you have not had anything to eat or drink for the length of time your surgeon told you, usually 6 hours.
• Check your medical chart for any allergies you have and any medicines you take.
• Answer any questions you or your family members have about your surgery. Tell the nurse who should be contacted right after your surgery to talk about how the surgery went and whether anything was found.
• Make sure you have a ride home.
• Explain to you what will happen and reassure you to help you remain calm. The nurse may go over the pain scale that is used to help see how you are doing after surgery.
• Ask you to urinate and change into a hospital gown.
• Ask you to remove any dental work, such as dentures or plates.
• Ask you to remove any hearing or visual aids, such as hearing aids or contact lenses.
• Give you the medicines ordered by the anesthesiologist during his or her visit with you before surgery. These medicines will help you relax.
• Give you antibiotics, if ordered by your surgeon.
• Give your family or friends instructions on how long you will be in surgery and in the recovery area. The nurse will also let your family or friends know where they can wait during your surgery.
• Start an intravenous (IV) line in your arm or hand, if ordered by your surgeon or anesthesiologist, for fluids and medicines before, during, and after your surgery.

Your surgeon or the surgical team may also give you some information on what will happen after surgery, such as whether you will have special equipment, like another IV, a urinary catheter, or wound drains.

During Surgery

The time you spend in surgery is known as the intraoperative period. A special surgical team helps the surgeon with your surgery. This team usually includes:

• A surgical technician (scrub), who passes instruments to the surgeon. Your surgeon may also have an office assistant who regularly helps in surgery.
• A registered nurse, who helps in many ways and writes the details of your surgery in your medical chart.
• A nurse anesthetist or anesthesiologist, who gives you medicines and monitors your vital signs.
• Other medical personnel, such as an X-ray technologist, who may be needed for your surgery.
• Another surgeon to help your primary surgeon, if needed.

In university or teaching hospitals, doctors with different levels of surgical training may watch or help with your surgery. But your surgeon will be in charge.

The surgical team is trained to provide you with safe care during your surgery. If you are having general anesthesia, a breathing tube (endotracheal tube) is placed in your windpipe or a special airway (laryngeal mask airway, or LMA) is placed in the back of your throat to help you breathe during the surgery. The place on your skin where the incision will be is washed with a special solution to remove bacteria. All instruments used during your surgery are sterilized to reduce your risk of infection.

For more information on anesthesia options, see the topic Anesthesia.

After Surgery

Postoperative risks

Your surgeon and the surgical team will keep you safe during your surgery. But surgery is never risk-free. Your surgeon will review all risks related to your surgery. The most common problems after surgery are pneumonia, bleeding, infection, clotted blood (hematoma) at the surgery site, or a reaction to the anesthesia.

In the first 48 hours after surgery, the most likely risks are bleeding or problems with your heart or lungs.

From 48 hours to 30 days after surgery, the most common risks are infection, blood clots, or problems with other body organs, such as a urinary tract infection.

In the recovery area

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. A nurse will check your vital signs and bandages. He or she will also ask about your pain level, which likely will have already been explained to you before surgery. You will most likely stay in the recovery area for 1 to 4 hours, and then you will be moved to a hospital room or you will go home. You may receive medicine or fluids through your vein (intravenous, or IV) during your time in the hospital.

If you go home, the nurse will give you instructions on breathing and exercises to help prevent any problems. For most minor surgeries, the nurse will encourage you to be as active as possible to prevent these problems.

Pain control is an important concern after surgery. Near the end of your surgery, your surgeon may inject a long-acting pain medicine at the site of your surgery to decrease your pain for 6 to 12 hours after surgery.

Relief of any nausea or vomiting is also an important concern. If you will be going home the same day, you will need to drink fluids without vomiting, be upright without fainting, and urinate on your own before you will be sent home.

Postoperative instructions

In addition to any special instructions from your surgeon, your nurse will explain information to help you in your recovery. You will most likely go home with a sheet of care instructions including who to contact if a problem arises. These instructions will include:

• Having someone else at home to check on you or arranging for a nurse to check on you.
• Which medicines you are to take and when, including medicines you take regularly.
• The level of activity that is safe for you to do. For example, the instructions will likely list when it is okay to drive, how much you can walk each day, how much weight you can lift, and what other things you can do as you recover. For most minor surgeries, you will be encouraged to be as active as possible to avoid problems.
• How to take care of your incision. The instructions will explain:
  • The best way to bathe and protect your wound, such as how to cover the area if needed and when it is safe to shower and let the incision get wet.
  • How to care for and change your surgical dressing.
  • What clothing to wear to avoid rubbing your incision area.
  • What symptoms to look for that may be a problem. Signs of a skin infection, such as a fever, increased pain, or increased drainage, need to be checked by your surgeon. Mild swelling and redness around the incision area is normal after surgery.
• What foods to eat and how your bowel and urinary habits may be different.
• The use of special equipment, such as a sling or crutches.
• When to have a follow-up appointment with your surgeon. Your surgeon will want to talk to you before your follow-up appointment if:
  • You are not sure about your home care instructions. Ask right away if you have any questions about wound care or drainage.
  • You develop a symptom or problem that you do not know how to handle.
  • You develop an unexpected symptom or problem.
  • You are not able to take your prescription medicines.

A nurse will review these instructions with you. He or she can also help arrange for any care you will need when you go home. This may include scheduling nursing care or visits from other health professionals.

When should I call my surgeon?

If you have any symptoms that require emergency treatment, call 911 or other emergency services immediately. The symptoms to watch for include:

• Signs of shock.
• Moderate to severe difficulty breathing.
• Severe pain.
• Shortness of breath with a rapid heartbeat. These may be symptoms of pulmonary embolism.
• Chest pain that is crushing or squeezing, is increasing in intensity, or occurs with any other symptoms of a heart attack.
• An increase in leg swelling. This may be a sign of deep venous thrombosis, a condition in which blood clots form that can be very serious if not treated.

Your recovery from surgery may be different from what your surgeon expected. Other symptoms or problems may develop after your surgery even when you follow your surgeon's instructions. This can be very frustrating.

Be sure to call your surgeon if you have an unexpected symptom or problem, including:

• Nausea and vomiting. If you are not able to keep fluids down, you may become dehydrated.
• Difficulty swallowing.
• Pain that does not go away when you take your pain medicine.
• A temperature higher than 101 °F (38 °C).
• Difficulty urinating or having a bowel movement.
• Loose stitches or an open surgical wound.
• Red streaks or pus draining from your wound.
• A rash.

References

Other Works Consulted

• Doherty GM (2006). Preoperative care. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 6–12. New York: McGraw-Hill.

• Den Herder C, et al. (2004). Risks of general anesthesia in people with obstructive sleep apnoea. BMJ, 329(7472): 955–959.

• Doherty GM (2006). Postoperative care. In GM Doherty, LW Way, eds., Current Surgical Diagnosis and Treatment, 12th ed., pp. 13–20. New York: McGraw-Hill.

• Fakhry SM, et al. (2004). Routine postoperative management of the hospitalized patient. In WW Souba et al., eds., ACS Surgery Principles and Practice, chap. 6, pp. 79–99. New York: WebMD.

• Gross RJ (2007). Preoperative planning for ambulatory patients. In NH Fiebach et al., eds., Principles of Ambulatory Medicine. 7th ed., pp. 1605–1633. Philadelphia: Lippincott Williams and Wilkins.

• Hardin RE, Zenilman ME (2005). Surgical considerations in the elderly. In FC Brunicardi, ed., Schwart's Principles of Surgery, 8th ed., pp. 1835–1849. New York: McGraw-Hill.

• Hernandez AF, et al. (2004). Preoperative evaluation for major noncardiac surgery. Archives of Internal Medicine, 164(16): 1729–1736.

• Lubin MF (2004). Preoperative assessment and care of the surgical patient. In DC Dale, DD Federman, eds., ACP Medicine, section 8, chap. 4. New York: WebMD.

• Smeltzer SC, et al. (2008). Postoperative nursing management. In SC Smeltzer, BG Bare, eds., Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 11th ed., chap. 20, pp. 523–549. Philadelphia: Lippincott Williams and Wilkins.

• Smeltzer SC, et al. (2008). Preoperative nursing management. In SC Smelter, BG Bare, eds., Brunnar and Suddarth's Textbook of Medical-Surgical Nursing, 11th ed., chap. 18, pp. 480–501. Philadelphia: Lippincott Williams and Wilkins.

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