Perioperative Instructions

Nutrition

Eating a healthy diet and staying hydrated in the weeks and days before and after your surgery is critical for recovery. It can help reduce you risk of infection, length of stay, and risk of readmission. Proper nutrition also promotes the healing of surgical incisions. We advise you to:

• Focus on eating protein rich foods, fruits and vegetables with each meal. Some healthy high protein options include baked (or grilled) chicken or fish, eggs, nuts, milk, and Greek yogurt.
• Drink plenty of water. Avoid alcohol.
• Are you a diabetic? Please take your medication as prescribed and follow a diabetic diet. High blood sugars can increase your risk of infection.

Shaving

Avoid shaving near the surgical site for FIVE (5) days before surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection.

Smoking Cessation

Plan to quit smoking as soon as you know you may need surgery. The sooner you stop, the more benefits there are. If you continue to smoke, you will be at an increased risk for surgical complications such as:

• Pneumonia
• High blood pressure, increased heart rate, and irregular heart beat (arrhythmia)
• Blood clots
• Delayed wound healing, wound infection, cell and tissue death, and hernias at the wound site.

Need Help Quitting?

• Georgia Tobacco Quit Line: 1-877-270-7867
• Tobacco Cessation Program: 706-721-0456

Transportation

If you are going home the same day as your surgery (outpatient), bring someone to drive you home the day of surgery. For your safety, a responsible adult must remain with you for 24 hours after surgery.

Medications

• Please take your medications as prescribed.
• One week prior to surgery you need to stop taking:
  • Vitamins, fish oil, and other supplements.
  • Ibuprofen (Motrin, Advil), Naproxen (Aleve), Diclofenac, Indomethacin, these are NSAIDs (nonsteroidal anti-inflammatory drugs).
  • If you take Aspirin, or any other prescription blood thinners (Coumadin, Xarelto, Plavix, Eliquis, Pradaxa), please let your surgeon know as soon as possible. Your surgeon and prescribing physician will give you instructions prior to surgery.
  • Your PAT nurse will tell you which medications to take day of surgery.

Incentive Spirometer

An incentive spirometer is a hand-held device that helps exercise and expand your lungs. If you are given one before your scheduled surgery, go ahead and start practicing! This tool is used to prevent pneumonia and other complications with your lungs after surgery.

Anesthesia is a treatment using medications to keep you comfortable or make you sleep during surgery. You will meet with your anesthesia team and sign your anesthesia consent on the day of your surgery.

There are different types of anesthesia you can get:

• Sedation/Monitored Anesthesia Care (MAC): Your anesthesia provider will give you medications to keep you calm and treat discomfort during your procedure without having you go to sleep completely. You may be aware of your surroundings, but you will be given enough medication to make you as comfortable as possible
• General Anesthesia: Your anesthesia provider will give you medications that will put you completely to sleep during the procedure. You will not be aware of what is happening, nor feel any pain or discomfort.
• Regional (nerve block, spinal, epidural): Your anesthesia provider will inject numbing medications close to nerves. This will cause a temporary loss of feeling and movement in the part of the body where the procedure will be performed. You may be awake, but you can be given medications to make you sleepy (see MAC above). Sometimes a nerve block can be done after your procedure to help with pain.

Pre-Anesthesia Testing (PAT) Clinic

An essential part of preparing for your surgery includes a comprehensive evaluation completed by one of our nurses in the PAT Clinic. This pre-op assessment is used to evaluate any risks associated with anesthesia. We want ensure that you have a safe surgery and recovery.

Contact the PAT Clinic
Phone: 706-721-3005
Fax: 706-721-1053

Within 30 days of your scheduled surgery, you will be scheduled for your PAT assessment via telephone or in person. During this appointment be prepared to review the following:

• A list of all medications you take. This includes prescription, nonprescription, supplements, or any over-the-counter medications.
• Food and medication allergies.
• A list of names and phone numbers of your primary care doctor and any other specialist you visit (heart or lung doctor).
• We will ask several questions about your health and anesthesia history. 
• We will give you pre-op instructions, including what medications to take day of surgery. 
• We may need to request your medical records from facilities that are outside of Augusta University to help us better understand your health history.

ERAS

The Enhanced Recovery After Surgery (ERAS) is a pathway that is utilized with specific surgeries and surgeons. If you are in this program, your appointment scheduled with one of our ERAS navigators during your pre-anesthesia testing (PAT) phone interview.

• ERAS education booklet
• ERAS education booklet (Spanish) 
• Opioid Patient Toolkit

Day Before Surgery

The day before surgery, please follow these instructions:

• Bathing instructions: Most infections after surgery come from the bacteria living on your skin. You will be instructed to use CHG wipes or anti-bacterial soap before your surgery
• Find out your arrival time: You will be given an arrival time the business day prior to surgery, after 3:00pm. However, surgery times are sometimes delayed because of emergencies or unexpected circumstances. We will let you know if there is a delay and keep you updated as we receive information.
• Do NOT eat: Do not eat anything after midnight the night before surgery. If you are an ERAS patient follow the instructions given by your ERAS nurse. Nothing by mouth includes: coffee, gum, candy, mints. You may have small sips of water until 2 hours before scheduled arrival time.

Day of Surgery

On the day of your surgery, be aware of what you need to bring and do, before you come to the hospital. 

What to bring to the hospital:

• A responsible adult to drive you home.
• ID, insurance cards, Medicare cards, etc.
• Credit /debit card for co-pays or prescriptions.
• A list of your medications, this includes medication name(s), dose, how often you take them, and the last date and time you took each one.
• A copy of your Advance Directives for Health Care, if you have one.
• Any personal assistive devices (cane, walker, or crutches).
• Storage cases if you wear glasses, contacts, dentures, or hearing aids.
• Personal items such has toothbrush, hairbrush if you are going to be admitted to the hospital after surgery.
• Portable oxygen tank, if you are currently on oxygen.

Checklist BEFORE you arrive at the hospital:

1. Take the medications your PAT nurse told you to take with enough water to get them down.
2. Oral hygiene: Brush your teeth and use an antiseptic mouthwash.
3. Take off all jewelry and leave all valuables at home.
4. Wear loose comfortable clothing.
5. Do NOT wear makeup, oils, lotion, perfume, deodorant, acrylic nails, or hairpins.
6. Check the what to bring to the hospital list.

How to Find Us

AU Medical Center is located: 1120 15^th Street, Augusta, GA 30912.

1. Park in the 15th Street Parking Deck (Medical Center Parking Deck 1)  located at entrance number 3 across from the Econo Lodge Hotel. Enter the hospital through Entrance B.
2. Go to Patient Access Services (straight ahead as you enter through Entrance B) to check in and get your patient arm band.
3. Take the B elevator to the 8th floor, and check in at the 8 West desk (to the left as you come off the elevator)

What Happens Next?

The following is a general overview of the process, however, there may be slight differences or changes on the actual day of surgery depending on what's going on in the hospital.

• You will be taken to a patient room where your vital signs (blood pressure, heart rate, temperature) will be checked and you will change into a hospital gown. A nurse will get you ready for surgery, they will ask questions (to make sure your paperwork is complete), start your IV, and collect any lab work ordered by your doctor.
• You will clean your skin again with CHG wipes and brush your teeth.
• Your nurse will perform a nasal prep for MRSA decolonization. This reduces nasal bacteria and decreases your risk for surgical site infection.
• A family member can stay with you while you get ready for surgery or wait in the Family Welcome Room on the 8^th floor (8 West) by the D elevators.
• You will stay on 8 West until they are ready for you in the Operating Room (OR). You will have a scheduled surgery time, however, sometimes there are delays because of emergencies or unexpected circumstances. We will let you know if there is a delay and keep you updated as we receive information.
• From pre-op, you will be escorted to the first floor where you will meet your surgical team (surgeon, anesthesiologist, operating room nurse). You can have one family member/guest come with you.
• Once you leave for the OR, your family member/guest will need to go to the Family Welcome Room and check in at the concierge desk. The concierge can provide updates as they are available. There is also a communication board / TV screen in the Family Welcome Room where your family member/guest can track your progress with the identification number they were given at check in.
• The surgeon will talk with your family after your surgery is complete.
• After surgery, you will be taken to the Recovery Room (Post-Anesthesia Care Unit - PACU) until you are more awake and your breathing, pain and nausea are under control.
• Pain after surgery is normal. Our goal is for your pain to be tolerable.
• Admitted patients: If you are staying overnight after surgery, you will be taken to your hospital room or Intensive Care Unit (ICU) after you leave the recovery room. Sometimes, there is a delay that extends your length of care in the PACU.
• Outpatient: If you are going home the same day as your surgery, you will go from PACU back to a patient room on 8 West. Your nurse will make sure your pain and nausea are tolerable and provide discharge instructions to your family member before you go home.

When can I go home?

Pharmacy

For your convenience, our outpatient pharmacy offers free delivery of your medications prescribed for after surgery. The medications will be delivered to your room before you go home. Please let your surgeon and/or nurse know if you are interested in this service so arrangements can be made.

Follow-up Appointment

Before leaving the hospital, your surgeon will determine when you need a follow-up appointment. You will receive this appointment prior to your discharge home.

Follow-up Phone Call

If you are going home the same day as your surgery, you will be contacted by a nurse, typically 1-3 days after discharge, to assess how your recovery is going.