Patient Instructions

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Better Preparation, Better Outcomes

A patient’s risk of negative outcomes from surgery can be lowered by preparing for surgery using best practices. Enter ACS Strong for Surgery. This important and well-researched initiative brings a pre-surgery checklist to surgeons' offices to help with education, communication, and standardization of best practices to improve outcomes for patients. The better the preparation, the better the recovery. That’s Strong for Surgery.

Preoperative Checklists

The checklists are used to screen patients for potential risk factors that can lead to surgical complications, and to provide appropriate interventions to ensure better surgical outcomes. The checklists target eight areas known to be highly influential determinants of surgical outcomes:

  • Nutrition. It is important to eat healthy foods before your operation. Tell your surgeon if you have trouble eating or if you have not been very hungry. Also tell your surgeon if you have lost weight without trying, have difficulty swallowing, or are not tolerating food. Your surgeon may want you to see a dietitian, who can help you work out an eating plan to help prepare you for your operation.

  • Glycemic Control. If you have diabetes, you know how important good blood sugar control is. Your surgeon needs to know what your recent blood sugar test results have been. On the day of your operation, your surgeon should check your blood sugar before your operation. Having surgery puts stress on your body and stress can affect your blood sugar level. Blood sugar that is too high or too low can cause serious problems. Keeping blood sugar in control before, during, and after your operation will reduce your risk of infection in your incision and will help you heal better. Even if you haven’t been told you have diabetes, your surgeon may want to check your blood sugar. Many people have high blood sugar and don’t know it.

  • Medication Management. Your surgeon needs to know what medicines, over-the-counter drugs and supplements, and herbal remedies you are taking. Some of these can increase your risk of bleeding. Your surgeon will tell you which ones to stop taking—and when to stop them—before your operation. Some medicines should not be stopped. If you are taking one of these, your surgeon will make sure the hospital staff knows so that you get the right medicines before and after your operation.

  • Smoking Cessation. Smoking increases the risk for many problems after your operation (make it hard for you to breathe, make an infection at the incision site more likely, increase the chance of having a heart attack). Quitting will reduce risks and improve your overall health.

  • Safe and Effective Pain Management after Surgery. Controlling your pain after your surgery is important aspect of recovery. To help you have a successful surgical experience, it is important for you to have a presurgical discussion with your surgeon about how he or she will work with you to manage your pain. Your physician may discuss using a combination of strategies to control pain. These alternative ways to control pain can be helpful and sometimes may provide better pain relief than medication alone. You may also be screened for current opioid use and potential risk for overuse. To ensure the safety and most effective way to control people the physician may advise using the lowest dose of opioids, safely getting rid of unused opioids, and knowing the signs of opioid overuse. The clinical team want to make ensure that you are informed about managing your pain in a positive manner.

  • Delirium. More than 7 million hospitalized Americans suffer from delirium each year. Delirium is a state of confusion that comes on very suddenly and can last from hours to days. The elderly are particularly impacted with delirium relating to a hospital admission, but bear in mind that a number of different things can cause delirium. Your surgeon and health care team will work with you and your family to screen for risk factors, and may possibly refer you for further evaluation and give your caregiver tools on how to manage delirium should you experience it.

  • Prehabilitation. Prehabilitation is defined as a process of improving the functional capability of a patient prior to a surgical procedure so the patient can withstand any postoperative inactivity and associated decline. In other words, to get you to a better place physically before an operation. Generally, the more fit and active you are going into a surgical procedure, the more likely you are to retain a higher level of function after. It is important for you to know and work on any functional deficits prior to your operation.

  • Patient Directives. Having an operation can be overwhelming. There are many things to consider before going in for surgery. The health care team may provide you with specific information related to the operation you are having. Review this material as it may help you understand what to expect from the procedure. Another topic to consider discussing with your surgeon are the costs related to the procedure. You may be referred to a social worker or a financial counselor to discuss the costs and payment options. Care provider details will also need to be discussed and confirmed. During this discussion, it may be helpful to go over advance directives and your living will options. They may not be needed for the procedure, but will help you establish them for yourself and your family.