Planning for Surgery
Smoking | Jewelry | Nail Polish | Dentistry
Surgery of any kind is an important part of your life. Hand surgery will disrupt your usual activity and advance planning will help. Planning for surgery will start with a visit to your surgeon. You and your surgeon will discuss the indications for surgery, the alternatives, the expected results and a possible date for surgery. The surgical booking coordinator in our office will work with you to find the appropriate date and time. Prior to surgery you will have to have a history and physical examination performed by one of our physicians, physician assistants or nurse practitioners or possibly your primary care physician. A consent will have to be signed.
Smoking is one of the most common causes of preventable death. Smoking also affects musculoskeletal health. There is an increased risk of osteoporosis, injury and disease. Smoking has a detrimental effect on bone healing (fractures, nonunions and osteotomies) and wound healing. Post-operative complications are more common. Stop smoking now! Visit the American Lung Association's Freedom From Smoking® online program today. If you are having surgery we would suggest that you stop smoking and the use of transdermal nicotine for a minimum of 4 weeks prior to surgery, longer if possible. (Smoking and Hand Surgery JHS 2013). This is especially important for bone healing operations including but not limited to nonunion surgery and osteotomies (i.e. ulna shortening etc.). Elective surgery may have to be postponed.
Ambulatory surgery patients (people who will be going home after surgery) must make arrangements for someone (family member or friend) to pick you up after surgery. You will not be allowed to drive home if you have had any sedation, which includes all anesthesia except local anesthesia. You are not allowed to take a taxi home alone. You must be accompanied by an adult other than the driver. Your surgery may need to be postponed if you do not have a ride. Please notify the office if this poses a problem. Remember you should not drive for 24 hours after anesthesia that includes any sedation. Also you cannot drive while taking narcotics or judgment altering medications. (See Living with an Injured Hand)
All jewelry (including rings) must be removed from both hands and ears. Please look into this early. A jeweler may have to remove your rings. Please also remove nail polish from both index fingers prior to surgery.
Avoid any breaks in the skin in the extremity to be operated on. Therefore be careful what you do in the weeks prior to surgery. Please call the office if there are any questions. Surgery may have to be postponed.
Infections- You can not have any infections anywhere (skin, mouth, teeth etc.) at the time of surgery. Please call the office if there are any questions. Surgery may have to be postponed.
Remove all chipped or peeling nail polish. Please do not have manicures for 2 weeks prior to surgery. Small breaks in the skin can increase the incidence of infection. If possible try to avoid activities that could cause breaks or irritation in the skin.
All patients who are having total joint replacement (total elbow arthroplasty, total wrist arthroplasty) surgery should see a dentist at least one month prior to surgery because dental work should be discouraged post operatively if possible for 6 months after surgery. Postoperatively after Joint replacement (Elbow, wrist) antibiotic prophylaxis for dental procedures may be needed for high risk individuals having high risk procedures that will cause a bacteremia. This depends on whether the gingival tissue is being manipulated or there is perforation of the oral mucosa, whether the patient is immunocompromised, whether the patient has diabetes mellitus and if their glucose is under control, history of previous prostatic infection and length of time since the joint replacement. In 2016 the AAOS board approved an Appropriate Use Criteria (AUC) for management of patients with orthopedic implants undergoing dental procedures. Please go to this webpage and there is an algorithm to determine if antibiotics are appropriate. This is a guideline and you should speak to you your surgeon if you has any questions. The full AUC pdf is also available. Usually if it is less than 6 months post joint replacement we would recommend antibiotic prophylaxis. Again please check with your surgeon. The antibiotic of choice and dosage recommendations are provided as an additional resource and based solely on the 2007 statement released by the American Heart Association. If antibiotics are indicated usually Amoxicillin 2 grams 30-60 minutes prior to the procedure is recommended for patient's without an allergy to penicillin/ampicillin.
Preadmission Screening (PAS)
Preadmission screening is a process which will involve a transfer of information between you and the facility where you are having surgery. An actual visit to the facility may or may not be necessary. The PAS process is designed to allow appropriate medical evaluation prior to your surgery. It is a very important part of your surgery and should be treated as such. It will help ensure a safe and efficient day of surgery and help avoid delays. The process includes the appropriate history and physical (our physicians, physician assistants or nurse practitioners or possibly your primary care physician), laboratory studies (blood test, chest x-ray or EKG as needed). The need for the tests is determined by your age and medical problems as well as the type of procedure planned. Therefore it may be different for each person and procedure. Most patients will not need to visit the facility preoperatively. However, you may be asked to visit with the facility preoperatively based on your age, medical problems and procedure being performed. If you are asked to visit the facility it is for your safety and should be scheduled. PAS may include transfer of information over the phone, online or in person. Please have all insurance information available. Have a list of all your medications including doses, previous surgical procedures and all medical problems. If you have had substantial medical problems you may have to obtain previous medical records including but not limited to EKG, echocardiograms, stress tests, angiograms etc. Please have the names, addresses and phone numbers of your primary care physician and previous specialists involved in your medical care.
If you are required to visit the facility as part of your prescreening appointment it will usually be scheduled 3- 30 business days prior to surgery. Please allow a minimum of 2 to 4 hours for PAS visit. We recommend that you do not schedule other commitments on the day of PAS. If you are under 18 years old, a parent or legal guardian must accompany you.
If you have significant medical problems you may be required to be seen by your primary care physician prior to surgery.
If you have significant cardiac problems or are 80 years of age or older, you may need to be evaluated by a cardiologist. The staff of PAS, our surgical coordinator, or your primary care physician can help arrange this. Written documentation of the consultation including the ability to undergo surgery is required at least 3 business days prior to surgery.
If you are over 90 years of age and your surgery is at the NEBH you may need to schedule a second opinion prior to surgery. Please discuss this with your surgeon.
Please check with the prescreening office at the facility/hospital where your surgery will be performed with any questions.
Medications to Avoid
Please review you PAS material for a more complete list. All aspirin products should be stopped a week prior to surgery. If you are taking aspirin as a blood thinner prescribed by your physician please check with him or her. If for some reason you cannot stop taking aspirin please let us know immediately, your surgery may have to be postponed. NSAI (Motrin type medications) should be stopped 5 days prior to surgery. Cox II inhibitors (i.e. , Celebrex, etc) can be continued. If you are unsure please call our office and/or the PAS department at the facility where the surgery will be preformed. Let us know if this is a problem.
If you are taking coumadin the dose will have to be modified and the prescribing physician should inform you how to do this. Please let your physician know the plan. Your INR will be checked the day before (BOSS, NEBSC) or possibly the morning of the surgery (NEBH) and if not within a reasonable range, your surgery will have to be postponed. If your physician feels you cannot decrease your coumadin dose, let us know immediately. There may be a substantial risk of increased in bleeding if your INR is not in the appropriate range (safe). If you INR is not in the appropriate (safe) range this could result in an hematoma (collection of blood), increase incidence of infection, delayed healing, a suboptimal outcome and need for further treatment which may include medications, more surgery or therapy. If your INR is not in the appropriate (safe) range special arrangements may have to be made and/or your surgery may be postponed.
If you are taking Plavix we will usually want this stopped at least 5 days prior to surgery. This should only be stopped after you consult the prescribing physician. If your physician does not feel that stopping Plavix is in your best interest prior to surgery your surgery may have to be postponed. Please let us know immediately. There may be a substantial increase in bleeding if Plavix is not discontinued. This could result in an hematoma (collection of blood), increase incidence of infection, delayed healing, a suboptimal outcome and need for further treatment which may include medications, more surgery or therapy. If Plavix can not be stopped please let us know immediately. Special arrangements may have to be made and your surgery may need to be postponed or canceled.
If you are taking other anticoagulants such as Eliquis. Xarelto or others we will usually want this stopped at least a few days prior to surgery. This should only be stopped after you consult the prescribing physician. If your physician does not feel that stopping the medication in your best interest prior to surgery, please let us know immediately. Your surgery may have to be postponed. There may be a significant increase in bleeding if these medications are not discontinued. This could result in an hematoma (collection of blood), increase incidence of infection, delayed healing, a suboptimal outcome and need for further treatment which may include medications, more surgery or therapy. If these medications can not be stopped please let us know immediately. Special arrangements may have to be made and your surgery may need to be postponed or canceled.
Insulin and other hypoglycemic medications should be held the morning of surgery unless specifically directed by your primary care physician, surgeon or the surgery facility staff,
Herbal medications should be discontinued two to three weeks prior to surgery. Diet medicines for weight loss should be stopped two weeks prior to surgery by the physician who prescribed it. Vitamins and other supplements should be held the day of your surgery.