Preparing for Surgery

When you and your surgeon decide that surgery is the best course of treatment, the scheduling process starts with your surgeon filling out a surgery form.  This form is necessary to determine the type of procedure, its duration, and any special equipment needed for the case.  In addition, this form specifies any pre-operative testing the surgeon may want such as lab work, EKG, chest x-ray, vascular testing, and pre-operative or post-operative physical therapy.  If you do require any further testing for medical clearance, this must be set up prior to scheduling the surgery, and is typically scheduled by our physician coordinators.

The surgery form is often completed in the office after the initial discussion to pursue surgical treatment.  However, some of you may wish to discuss the decision for surgery with family members or your place of employment prior to formal scheduling.

Your surgeon will decide if you need to see your primary care physician or cardiologist prior to surgery for medical clearance, and will help you determine when that visit should be scheduled.

You will meet with one of our physician coordinators who will assist you in choosing a date for your surgery and where you will have your surgery performed, either one of the local hospitals or ambulatory surgery centers. Your physician coordinator will also schedule testing (if required).  If your surgery is scheduled and necessary appointments have been made prior to your leaving our office, you will leave with a printout of all your appointments and instructions for surgery.

If you decide to schedule your surgery after you leave the office, you may leave a phone message with your physician coordinator regarding your decision and timing for your surgery. You may also send an electronic message through our Athena patient portal.  Once your message has been acknowledged, your physician coordinator will request completion of the surgery form by your surgeon. Once the form has been filled in by your surgeon, the physician coordinator will call you to choose a surgery date, make the necessary appointments, and then, will mail you the necessary paperwork with further instructions.

You will be required to have a history & physical (H&P) examination prior to your surgery.  This is sometimes performed during the appointment when the decision for surgery is made.  However, more often than not, you will be asked to return to the office for a history & physical examination within 30 days of the planned surgery.  The H&P is performed by either the physician assistant or the surgeon.  If your surgeon has ordered testing or referred you to another physician, he will have all the results available for review at that appointment.

Pre-certification for surgery is typically required from insurance companies.  Once the physician coordinator has completed your paperwork and booked your surgery with the hospital or surgery center of your choice, your physician coordinator will alert the billing office staff who will contact your insurance company for required pre-certification.

All surgeons at Seacoast Orthopedics & Sports Medicine have operating room time at Wentworth-Douglass Hospital in Dover, Wentworth Surgery Center in Somersworth, Frisbie Memorial Hospital and Skyhaven Surgery Center in Rochester each week. Some of our surgeons also have privileges at Portsmouth Regional Hospital.  You, as a patient, may want to check with your insurance company to see if your benefits vary depending on the hospital or surgery center.  We do get pre-certification for you, but all insurance plans are different and it is your responsibility to know what is and is not covered.

Night before Surgery

On the night before surgery:

• Take a complete bath or shower.
• Do not take any medications after midnight, unless specifically ordered by your doctor.
• Do not eat or drink anything (including water, chewing gum, or mints) after midnight.
• Do not drink alcoholic beverages 24 hours before surgery and avoid heavy foods.

Day of Surgery

On the day of your surgery, make sure you bring the following items with you to the hospital:

• Your insurance card, driver’s license, and social security card to ensure your insurance company is appropriately billed.
• A living will, durable power of attorney, or other advanced directive, if you have one.
• A list of all your medications and their strengths, including aspirin, birth control pills, vitamins, herbal supplements, and prescription medications. Also, please make sure to let us know if you are allergic to any medications.
• The names and telephone numbers of two people to contact in case of an emergency (contacts can include family members, friends, or neighbors.)
• Any x-rays or other imaging studies relevant to your surgery (not performed at SOSMed).
• Any written orders your physician has given you.
• Children may want to bring a book, favorite toy, or blanket.

Furthermore, please remember:

• Do not eat or drink anything (including water, chewing gum, or mints) before surgery unless otherwise instructed by your physician. Eating and drinking can increase the possibility of problems and may cause your surgery to be delayed or canceled.
• Notify your physician if there is any change in your physical condition, such as a cold, fever, or infection that may cause your surgery to be delayed.
• If you are a diabetic, check with your physician about the use of insulin or oral hypoglycemic agents. You will likely receive further instructions from the anesthesiologist the day prior to your surgery.
• You may wear your contact lenses or glasses, but bring a case for storing them during surgery. You may wear your hearing aid, but bring a case for storage and an extra battery. We will provide a container for dentures if they need to be removed during surgery.
• Do not smoke the morning of surgery.
• Do not wear makeup or jewelry, and do not shave area to have surgery (as shaving increases risk of infection).
• Leave all valuables at home.
• Be sure to bring loose-fitting clothes to change into after your surgery that can be easily removed once you return home.
• A responsible adult must be available to receive instructions about your care, and drive you home from the hospital after your surgery.

Arriving at the Hospital

Plan to arrive at the hospital one and a half to two hours before your surgery is scheduled or as otherwise indicated. This is necessary to allow enough time for a thorough pre-surgery evaluation.

After you are registered, you will be taken to a private same day surgery holding room where you will change into a hospital gown. A nurse will take a brief medical history and check your vital signs. You will also meet with an anesthesiologist. Parents may remain with their children during this time.

When the nurse is taking your history, please remember to mention:

• If you wear dentures, including permanent dentures such as bridgework caps or crowns.
• Medication you have taken or brought from home.
• Any allergies.
• Special orders from your physician.
• Colds, fever, or infection.
• In the case of a child, any serious or chronic illness the child has had.
• Any problems you have had with previous surgery or anesthesia.
• Any family members who have had trouble with anesthesia.

Once it is determined that you are in a safe condition to have surgery, your family or friend may wait with you in the same day surgery suite until you are taken to the pre-operative holding room or to surgery. The pre-operative holding room is where patients undergo regional anesthesia such as nerve blocks prior to surgery.

It is sometimes necessary for us to change the operating room schedule. We will do our best to keep you informed of any changes that might delay the scheduled time of your surgery.

While you are in surgery, your family members and friends may remain in our Surgical Waiting Area. A beeper may be provided so we can let them know when you have been taken to the recovery room. The surgeon will meet with your family following surgery to discuss the details of the case.

For safety reasons, unattended children are not allowed in the Surgical Waiting Room.  Please arrange ahead of time for proper adult supervision of your children, or arrange for them to remain at home.

After Your Surgery

After your surgery, you will remain at the hospital until your physician and nurse have determined it is safe for you to go home. Depending on the type of anesthetic you received, you may be taken to the Post Anesthesia Recovery Unit where you will remain until you awaken, or you may go directly to the Same Day Surgery Unit where family and friends can rejoin you. There is no family visitation in the Post Anesthesia Recovery Unit.

While you are recovering, your nurse will closely monitor your blood pressure, heart rate, and respirations. You may feel dizzy, tired, or nauseous. This is due to the action of the medicine used during anesthesia. It is important to let the nurse know if you are having any pain. He or she will be able to give you medication to help control the pain or discomfort you might experience.

Before you leave the hospital, your nurse will make sure that you are able to walk, urinate, and take liquids. Your nurse will also go over home instructions with you and a responsible adult. You will be given a copy of these instructions plus any prescriptions that your surgeon wants you to have. Due to the memory-dulling effects of anesthesia, we highly recommend that you arrange to have someone present who can listen to these post-operative instructions with you and ask questions on your behalf.

Please arrange in advance for a responsible adult to stay with you for 24 hours following surgery.

When You Return Home

When you return home, please:

• Do not drive, operate any equipment, sign important papers, or make any significant decision during the first 24 hours after your surgery.
• Resume your food intake slowly, starting with chipped ice and sips of cola, ginger ale, or a lemon/lime drink.
• Avoid alcoholic beverages for 24 hours after medication or anesthesia.
• If severe dizziness, elevated temperature, excessive bleeding, prolonged nausea, heartburn, or other alarming symptoms should occur, call your physician immediately.

If you need to be admitted:

• Avoid alcoholic beverages for 24 hours after medication or anesthesia.
• If you are to be admitted to the hospital after your surgery, a room assignment will be made accordingly. A private room cannot be guaranteed due to availability; however, every effort will be made to accommodate your needs.

Reasons to contact your physician:

• Excessive redness, swelling, drainage, or foul odor from your incision.
• Temperature elevation over 101 degrees.
• Leg swelling, calf tenderness, or increased leg pain.
• Discomfort not controlled by medication.
• Chest pain, shortness of breath, or breathing problems.
• Burning, frequent, or difficult urination.
• Other significant questions or concerns.

Post-Operative Instructions:

Please visit the PT/OT Protocols page to review all of the documents that apply to your specific surgery.