Dr Rob Elliott, Orthopaedic Surgeon
Shoulder, Hip, Knee & Elbow Specialist

Pre Surgery

Preparing for success

 

Pre Surgery

Getting to the hospital

You should arrange to be taken to hospital by a relative, friend or taxi. You should not drive yourself unless you have arranged someone to drive you and your car home after surgery. You will not be allowed to drive after your anaesthetic while you have strong pain killers in your system. Many operations will prevent you from driving for up to 6 weeks. If your upper limb was operated on Dr Elliott make restrict your activites and ask you to wear a sling for a period. You should not drive while you are asked to wear the sling. 

Prehabilitation

Please continue to keep your affected joint moving and the muscles around the joint strong in the lead up to surgery. This will speed your post operative recovery and minimise the chance of post-surgical stiffness.

Infections/Illness

If you have a fever or are unwell prior to surgery, it is recommended to postpone your surgery. Please inform our office if you feel you may not be fit for surgery. 

Smoking

Smoking increases the risk of most complications. It can complicate your anaesthetic and it is advised to not smoke before the surgery. Smoking affects your blood’s ability to carry oxygen, and therefore delivery of crucial oxygen to a wound. This increases the risk of wound healing problems and increases the risk of repaired tendons, ligaments and bone not healing. 

Smoking also affects the white blood cells. These are responsible for fighting infection. Smokers have a higher rate of post-surgical infection. An infection can ruin the results of your surgery and in some cases cause permanent disability. If possible please refrain from smoking immediately before and in the months post-surgery whilst healing to maximise your chance of an excellent outcome. 

Smoke products and carbon monoxide are the primary enemy, so nicotine replacement such as patches, gum, or vaping are a better alternative. Nicotine also has a detrimental effect on wound healing and blood vessels growing into healing tissue. It is ideal to not take nicotine at all if possible. 

Skin preparation

Please ensure your skin is in good condition prior to surgery. A skin infection may require your surgery to be deferred. Please treat any fungal infections well in advance of surgery. You should shower regularly prior to surgery and on the morning of surgery. Please do not apply moisturising cream to the skin over the joint which is to be operated on, on the day of surgery.

Hair removal

Please do not shave the skin of your affected joint within 48hrs of surgery. This has been shown to increase the number of bacteria on the skin. We will clip hair over the operative site immediately prior to surgery if necessary. Please remove any nail polish from finger and toe nails. This interferes with our sensors that measure oxygen levels. 

Jewellery

Please do not bring items of high value such as jewellery to hospital. Please ensure rings and jewellery are removed from the operative limb. If these can not be removed (e.g. wedding bands that have been on for many years) we may have to cut them off. We cannot procede with surgery without removing these.

Fasting

Please ensure you are fasting for surgery. You must not eat for at least 6 hours prior to surgery.

If your surgery is in the morning, please refrain from eating after 0200. 

If your surgery is in the afternoon, please have an early, light breakfast and fast from 0700. An example of a light breakfast would be some toast and tea or coffee. You should not have any fried or fatty foods for this meal.

Clear Fluids are generally permitted up to 2 hours prior to surgery. This should not be more than 200ml/hr.  Clear fluids are water, pulp free fruit juice, clear cordial, black tea and coffee. Cloudy or milk based drinks are not to be taken.You should be able to read newsprint through the glass of fluid for it to be classified as ‘clear fluid’. Avoid fizzy (carbonated) drinks.

Chewing gum and alcohol should also be avoided.

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Medications

In general, you should take your usual morning medications with some water, ideally two hours or more prior to surgery.

  • Blood thinners - if you are taking blood thinners these will generally need to stopped well in advance of surgery. Please inform your surgeon of which blood thinner you are taking and why. Blood thinners can protect you from medical problems such as heart attacks and stroke, but also increase your bleeding risk at and after surgery. Bleeding can cause increased pain, large haematomas, oozey wounds and is a risk for infection. The timing of stopping and starting blood thinners is a balance of risk. 
  • ACE inhibitors - these medications are used to treat high blood pressure. These should be stopped on the day of surgery. 
  • Beta Blockers - these medications are used to treat high blood pressure and heart rate issues. You should continue to take this medication on the day of surgery unless told otherwise.
  • Diabetic medication - These medications may be withheld in line with your fasting times, particularly oral diabetic agents. If you are on insulin your anaesthetist may get you to alter your dose for this on the day of surgery. They will advise you as necessary.