The PreOp-Guide
A Patient's Guide To Surgery
Chapter 1

     The PreOp-Guide is designed to be a helpful tool in your preparation for surgery.  In it you will find useful information that will enable you to more fully understand the process associated with preparation for and recovery from general surgery.  This guide is not intended to replace interaction with your health care providers, instead its purpose is to enhance this interaction by making you a more informed patient.  Like it or not, in today’s health care world, it is the rare physician who has the time to answer all of the many questions you are sure to have.  Often, patients and family members are hesitant to ask even the most basic questions of their physicians for fear of alienating themselves from their doctors.  At the same time, we now live in a world where information is power, and patients are no longer content to sit back and let the course of their care be dictated by someone else.  By reading the PreOp-Guide and completing the PreOp-Worksheet contained within it, you will be better prepared going into surgery and, hopefully, will not have questions which remain unanswered.

     This guide is divided into several simple chapters.  It was developed to give patients who are scheduled for elective surgery a chance to have their questions answered prior to their procedure.  The information in the guide is equally applicable to patients who have emergency surgery, but obviously they won’t have the luxury of reading this guide before their operation.  In writing it, I intentionally chose to avoid a lot of medical jargon you will hear before, during, and after your trip to the hospital.  This was done to make it easy to quickly read the guide before your operation.  However, over the course of your hospitalization, you are probably going to hear a number of medical terms that you are unfamiliar with, so the final chapter of the book is a glossary of medical terms.  I suggest that you read the guide as far in advance of your operation as possible.  This is not always easy, since often the time between seeing your physician and having your surgery is only a matter of days to weeks.  

     When the time comes to go to the hospital, put the guide in the bag you bring with you, and take it out whenever you run into a situation you don’t understand.  Most people find the process leading up to – and more importantly – following surgery to be hard to comprehend.  You will often be asked to do things that are frankly unpleasant, and not knowing why they are important sometimes makes it difficult for you to comply.  I have found, however, that when people know why they are doing things, and also why they should avoid doing certain things, it becomes easier for both the patient and the hospital staff to work together.  Remember that no matter what type of surgery you are having, or where the procedure is going to take place, the bottom line of the entire process is your successful recovery.  Surgeons are a dedicated group of highly trained professionals who cure disease by performing a carefully controlled injury.  When doing so, we often run the risk of causing significant complications or further injury.  It is crucial, therefore, that patients be very well studied and prepared before the operation and that no minor detail be overlooked after the operation.

     Probably the most important chapter in the book is the one pertaining to your preoperative preparation.  Most surgeons will give you a page or two of written instruction prior to your surgery.  I would suggest that you follow those instructions to the letter.  They were developed through years of experience, and your surgeon is telling you that following those instructions gives you the best chance of having a successful operation and quick recovery.  I would like to make it very clear that surgical practices vary widely throughout the world, and people who practice surgery in different parts of the United States also use different techniques.  It is believed that the type of operation you undergo for any given illness is most related to where your surgeon did his or her training.  There is nothing inherently wrong with this, as the expression goes, “there is more than one way to skin a cat.”  Therefore, if anything you read in this guide contradicts the specific advice of your surgeon, follow your surgeon’s own guidelines.

     Although most surgeons will tell you how far in advance you should alter your diet or what medicines you should or should not take, many neglect to advise you that a few simple (and some not so simple) measures can be taken to greatly diminish your chance of complications.  These recommendations are all included in the chapter on preoperative preparation; and if you follow them, you will know that you have done all you could to go into the operating room in the best possible condition.  I would like to stress one more thing about preparing for surgery, and this is crucial.  You will be asked many very personal questions prior to your surgery, some of which you will find uncomfortable or perhaps downright offensive.  I cannot stress enough the importance of your being honest with yourself and with your doctor when answering these questions.  The preoperative period is a difficult, emotional time.  No one has surgery these days unless there is a significant problem, and adjusting to the thought that you are ill is difficult to do.  This may make you feel defensive or put upon, and it is tempting to gloss over other medical, social, or psychological problems in your quest to rid yourself of this disease.  Just remember that surgeons do not treat diseases, but rather treat patients.  Problems – such as heart disease, diabetes, obesity, alcohol or tobacco use, or drug dependency – all have an enormous impact on the outcome of your surgery.  If you have any medical or psychological conditions, your surgeon  needs  to know that about them before he or she can best care for you. 

     Currently over 20-million major surgeries and over 70-million surgical procedures are performed each year in the United States.  With the advancements in surgical technique, surgical instrumentation, intensive care units, and better anesthesia, surgery is safer today than it has ever been.  Most of you reading this guide will pass in and out of the hospital without a problem, and your recovery process will be uneventful.  You must keep in mind, however, that even the most minor procedure carries with it some degree of risk.  You could develop and infection in your wound; the disease may be more extensive than initially thought, or you may have an allergic reaction to one of the prescribed medications.  It is for these reasons that surgical procedures are not performed lightly.  Your physician will have to weigh the risks posed by surgery against the expected benefit you will enjoy from undergoing the procedure.  This is a discussion you should have with your doctor when he or she is outlining the treatment options available to you.  In many cases there is no right or wrong answer; and the decision to proceed, and how to proceed, depends upon your wishes and your surgeon’s abilities.

     There are a few more things you should consider before going into surgery.  The first is how you want the information about the operation and your state of health conveyed to your family and friends.  Some people live very open lives, and do not mind that detailed information about their bodies is shared with family, friends, and neighbors.  On the other hand, some people prefer to live very private lives, and the thought of their medical condition being shared with anyone is a repugnant prospect.  Discuss this with your family or friends who will attend to you before and after your operation.  This information should also be shared with your medical provider, who will ultimately be responsible for dispensing this data.  The second issue you should discuss is what you would like to happen in the event that something goes wrong.  I mention this not to scare you; but because realistically, there is always the possibility of death associated with even the most seemingly trivial operation.  You should designate a close relative to be your spokesperson if you become unable to make decisions for yourself.  Some people prefer to formalize this relationship by obtaining a durable power of attorney, which is a legal document that gives someone else the authority to make decisions for you in the event you become incapacitated.  Whatever method you choose, you should have this discussion with one or more of the people that are close to you.  Frequently in the face of grave problems, family members find that they really have no idea what your wishes are.

     With all of this said, it is now time to prepare you for your experience.  In the upcoming chapters, you will learn more about the process you will face prior to surgery, what to expect when you arrive at the hospital, and what will happen to you after your surgery is over.  If you find that you don’t understand some of the information provided, remember to bring this guide with you to the hospital.  Referring back to the guide while you are experiencing the pre- and post-operative situations described may answer your questions.  

Chapter 2
Chapter 3
Chapter 1
Chapter 4
Chapter 5
Chapter 6
Chapter 8
Chapter 9
Chapter 10
Chapter 11