A safe, smooth surgical experience.
Before Surgery
Before your surgery
Prior to surgery you will be provided with a pre-operative information pack. There will be instructions on hygiene leading up to the surgery and when to stop eating and drinking, and which medications to stop or continue on the day of surgery.
Preparing for surgery
This will include a health questionnaire for you to complete and return. This information will be forwarded to the anaesthetist to review. On some occasions it may be necessary to meet the anaesthetist or a peri-operative physician prior to your surgery to ensure that your medical conditions are optimised and to make the surgery as safe as possible. This may require medical investigations such as blood test, or heart and lung investigations.
Planning for your return home
Following your surgery and anaesthetic you will not be allowed to drive home so will need someone to pick you up from hospital.
It is important to think about your home environment and post operative supports and plans for your initial recovery at home. This may require arranging a family member or friend to stay with you for the first few days to 2 weeks depending on your procedure and progress.
Pre-operative optimisation
Many conditions benefit from Prehab (pre-operative rehabilitation). This can be in the form or regaining ROM and control following an acute injury. Or maintaining strength and control in a degenerative condition.
There may be targets to meet prior to surgery and it may be beneficial to utilise the support of a physiotherapist in the prehab. There are some medical conditions that impact surgical outcomes. Unless it is emergency surgery it is important to optimise these to minimise surgical risks.
Diabetes
Diabetic management is an important perioperative consideration and has significant implications for surgical infections. In joint replacement surgery your HbA1c should be less than 7.6 before proceeding to elective surgery. This may require changes to your medications and diet in conjunction with your general practitioner and dietitian.
Smoking
Smoking including vaping is another risk factor for surgical complications. These can include issues with healing of the bone, soft tissues, and wounds. This can result in failure of the procedure or infections. Medical complications can cause issues with the anaesthetic or result in blood clots. For some surgeries the risk of proceeding in active smokers is too great and should be postponed until smoking can be ceased. Smoking should not be recommenced for at least 3 months post operatively.
Obesity
Obesity can also cause issues with the safety of elective surgery. Joint replacement surgery has a proven relationship between obesity and increased risk of failure and the requirement for revision surgery.
Medications to stop prior to surgery
For Elective surgery we usually recommend ceasing blood thinners prior to surgery. This should be discussed with your prescribing physician or cardiologist. Your personal circumstances may dictate a specific regimen to follow.
Aspirin – Aspro, Cartia etc
In general, 7 days prior to surgery
Antiplatelet – Ticagrelor, Clopidogrel
In general, 7 days prior to surgery
DOACs – Pradaxa, Xarelto, Eliquis, Savaysa, Bevyxxa
In general, 3-5 days prior to surgery
Warfarin
In general, 5-7 days prior to surgery and possible bridging therapy with Clexane may be required if you have a high risk profile.
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Diabetic Medications leading up to surgery
These are common diabetes medications that may require special management before surgery:
Metformin – a standard oral diabetes medication.
Insulin – injected medication to control blood sugar.
SGLT-2 inhibitors – a newer type of oral medication (e.g., Jardiance, Forxiga) that can increase risk of dehydration or ketoacidosis around surgery.
GLP-1 analogues – injectable medications (e.g., Ozempic, Trulicity) that can affect digestion and blood sugar.
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Rheumatoid Arthritis Medications
DMARDs