Surgery Preparation: Before and After Your Operation

What Should You Do Before Surgery?

Before surgery, you should attend a pre-operative assessment 1-2 weeks prior, review and adjust medications as directed, follow fasting instructions (typically 6-8 hours for food, 2 hours for clear fluids), stop smoking if possible, and arrange transportation and post-operative care. Proper preparation reduces complications by up to 50%.

Preparing for surgery begins well before your operation date. The goal is to ensure your body is in the best possible condition for the procedure and recovery. Modern surgical protocols, particularly Enhanced Recovery After Surgery (ERAS) programs, have revolutionized how we prepare patients, resulting in shorter hospital stays and fewer complications.

Your surgical team will provide specific instructions tailored to your procedure, but understanding the general principles helps you participate actively in your care. Research shows that patients who are well-prepared and understand what to expect experience less anxiety, require less pain medication, and recover faster than those who are unprepared.

The weeks before surgery are also an ideal time to optimize your overall health. If you smoke, stopping even 4-8 weeks before surgery significantly reduces complications. Managing blood sugar if you have diabetes, controlling blood pressure, and addressing any infections are all important steps that your healthcare team will help coordinate.

Pre-Operative Assessment

Most hospitals require a pre-operative assessment 1-2 weeks before scheduled surgery. This comprehensive evaluation serves multiple purposes: it identifies potential problems that could complicate your surgery, ensures you're fit for anesthesia, and gives you the opportunity to ask questions and understand the procedure.

During this assessment, you'll typically undergo blood tests, an electrocardiogram (ECG) if indicated, and possibly additional tests depending on your health status and the type of surgery. The anesthesia team will evaluate your airway, discuss anesthesia options, and review your medical history in detail. This is also when you'll sign consent forms and receive detailed pre-operative instructions.

Bring a complete list of all medications you take, including over-the-counter drugs, vitamins, and herbal supplements. Many supplements, such as fish oil, vitamin E, ginkgo biloba, and garlic, can increase bleeding risk and may need to be stopped before surgery. Be honest about your alcohol consumption and any recreational drug use, as these can affect anesthesia and recovery.

Physical Preparation

In the weeks leading up to surgery, focus on optimizing your physical condition. If you're able, maintain regular physical activity—even moderate walking improves cardiovascular fitness and aids recovery. Good nutrition is crucial; your body needs protein and nutrients to heal. If you're overweight, even modest weight loss can reduce surgical risks.

The night before surgery, shower or bathe using regular soap or the antiseptic soap provided by your surgical team. This reduces bacteria on your skin and lowers infection risk. Don't shave the surgical area yourself—this can cause micro-cuts that harbor bacteria. The surgical team will remove hair if necessary using electric clippers.

How Long Before Surgery Should You Stop Eating?

You should stop eating solid food 6-8 hours before surgery and stop drinking clear fluids 2 hours before. This fasting period, called "nil by mouth" or NPO, prevents stomach contents from entering your lungs during anesthesia—a serious complication called aspiration that can cause pneumonia or death.

Fasting before surgery is one of the most important safety measures in modern anesthesia. When you're under general anesthesia or sedation, your normal protective reflexes that prevent food and liquid from entering your lungs are suppressed. An empty stomach ensures there's nothing to regurgitate and aspirate.

The traditional "nothing after midnight" rule has been replaced by more evidence-based guidelines. Current research shows that prolonged fasting is unnecessary and may actually be harmful, leading to dehydration, low blood sugar, and increased stress on the body. The American Society of Anesthesiologists (ASA) guidelines now recommend:

• Solid food: Stop eating 6-8 hours before surgery (light meal like toast)
• Heavy, fatty, or fried foods: Stop 8+ hours before (may require longer)
• Clear fluids: Can be consumed up to 2 hours before (water, apple juice without pulp, black coffee, tea without milk)
• Breast milk: Infants should stop 4 hours before
• Infant formula/cow's milk: Stop 6 hours before

Many ERAS protocols actually encourage drinking clear carbohydrate-rich drinks up to 2 hours before surgery. These specially formulated drinks reduce hunger, thirst, and anxiety while providing energy for the metabolic stress of surgery. Your surgical team will advise whether this applies to your procedure.

Should You Take Your Medications Before Surgery?

Most essential medications should be taken as usual on the morning of surgery with a small sip of water, but blood thinners, diabetes medications, and certain supplements typically need adjustment or discontinuation. Always discuss your medications with your surgical team at least 1-2 weeks before your operation.

Managing medications before surgery requires careful planning because different drugs affect surgical outcomes in different ways. Some medications are essential and must be continued to prevent serious problems, while others significantly increase surgical risks and must be stopped. Your anesthesiologist and surgeon will review your complete medication list and provide specific instructions.

Understanding why certain medications are continued or stopped helps you follow instructions accurately. Blood pressure medications, for example, prevent dangerous hypertension during and after surgery. Heart rhythm medications prevent arrhythmias. Thyroid medications maintain your metabolism. Stopping these abruptly can cause serious complications.

Blood Thinners and Anticoagulants

Blood-thinning medications are among the most important to address before surgery because they significantly increase bleeding risk. However, stopping them also carries risks—particularly blood clots in people who take them for atrial fibrillation, mechanical heart valves, or recent deep vein thrombosis. Your medical team will balance these risks and may recommend "bridging" with injectable anticoagulants.

Diabetes Medications

Diabetes medications require special attention because fasting affects blood sugar control. The general principle is to avoid low blood sugar (hypoglycemia) during the fasting period while also preventing dangerously high blood sugar.

For type 2 diabetes, metformin is usually stopped 24-48 hours before surgery because it can cause a rare but serious condition called lactic acidosis, especially if you become dehydrated or have kidney stress from surgery. Sulfonylureas (glipizide, glyburide) that stimulate insulin release should be held on the morning of surgery to prevent hypoglycemia during fasting.

If you use insulin, your doctor will provide specific instructions. Typically, you'll take a reduced dose of long-acting insulin the night before and morning of surgery, while short-acting mealtime insulin is held when you're not eating. Your blood sugar will be monitored throughout your surgical experience.

Medications to Continue

Several medication categories should generally be continued right up to and including the morning of surgery:

• Blood pressure medications: Beta-blockers and most antihypertensives should be taken to prevent rebound hypertension
• Heart rhythm medications: Digoxin, antiarrhythmics maintain heart stability
• Thyroid medications: Essential for metabolic function
• Anti-seizure medications: Stopping risks seizures during vulnerable perioperative period
• Certain psychiatric medications: Many need continuation to prevent withdrawal
• Corticosteroids: Long-term users may need additional doses (stress dosing)

What Types of Anesthesia Are Used During Surgery?

The three main types of anesthesia are general anesthesia (you're completely unconscious), regional anesthesia (large area is numbed, like spinal or epidural), and local anesthesia (small area is numbed while you remain awake). Your anesthesiologist will recommend the safest and most appropriate option based on your surgery type and health status.

Anesthesia has transformed surgery from a terrifying ordeal into a safe, painless experience. Modern anesthesia techniques allow surgeons to perform complex procedures while keeping you comfortable and safe. Understanding your anesthesia options helps you participate in decisions about your care and know what to expect.

The choice of anesthesia depends on many factors: the type and duration of surgery, its location on your body, your overall health, any previous anesthesia experiences, and your preferences. Sometimes multiple techniques are combined—for example, general anesthesia with regional nerve blocks for post-operative pain control.

General Anesthesia

General anesthesia produces complete unconsciousness—you won't be aware of or remember the surgery. It's typically used for major operations, procedures inside body cavities, and surgeries where staying still is critical. Modern general anesthesia uses a combination of intravenous drugs and inhaled gases to achieve unconsciousness, pain relief, muscle relaxation, and amnesia.

During general anesthesia, you'll have a breathing tube placed after you're asleep to protect your airway and ensure adequate oxygen delivery. An anesthesiologist or nurse anesthetist monitors your vital signs continuously and adjusts medications to maintain the appropriate depth of anesthesia throughout the procedure.

After general anesthesia, you'll wake up in the recovery room (post-anesthesia care unit or PACU) feeling groggy and possibly disoriented. Nausea is common but treatable with medications. Most people feel relatively normal within a few hours, though you shouldn't drive, make important decisions, or drink alcohol for at least 24 hours.

Regional Anesthesia

Regional anesthesia numbs a large area of your body while you remain awake or lightly sedated. The most common types are spinal anesthesia (injection into the fluid around the spinal cord) and epidural anesthesia (injection into the space around the spinal cord covering). These are frequently used for lower body surgeries, cesarean sections, and labor pain management.

Peripheral nerve blocks target specific nerves to numb an arm, leg, or other body region. These are increasingly popular because they provide excellent pain control with fewer side effects than general anesthesia. Nerve blocks can be single-shot injections or continuous infusions through a small catheter.

Local Anesthesia

Local anesthesia numbs only a small, specific area and is used for minor procedures like skin biopsies, dental work, or removing small skin growths. You remain fully awake and alert. Local anesthetics work by temporarily blocking nerve signals in the treated area.

What Happens on the Day of Surgery?

On surgery day, arrive at the scheduled time having followed all fasting and medication instructions. You'll change into a hospital gown, have an IV placed, meet your surgical and anesthesia teams, and receive any pre-operative medications. The surgery itself may last from less than an hour to many hours depending on complexity.

The day of surgery can feel overwhelming, but knowing what to expect helps reduce anxiety. Hospitals have streamlined processes to ensure everything goes smoothly and safely. Your role is to follow instructions, communicate openly with your care team, and ask questions if anything is unclear.

Before the Operation

Arrive at the hospital or surgical center at your scheduled time—typically 1-2 hours before the actual surgery start time. This allows time for administrative check-in, pre-operative preparation, and addressing any last-minute concerns. Bring your identification, insurance information, and any paperwork you've been asked to complete.

You'll change into a hospital gown and store your belongings securely. A nurse will check your vital signs, review your medical history and allergies, confirm the procedure and surgical site, and start an intravenous (IV) line for fluids and medications. This is also when surgical site marking typically occurs—you and your surgeon will confirm together which side or location is being operated on.

You'll meet your anesthesiologist or nurse anesthetist, who will review your health history, discuss the anesthesia plan, and answer any questions. Your surgeon may also visit briefly to address any final concerns. Before being wheeled to the operating room, you may receive sedating medication through your IV to help you relax.

In the Operating Room

Operating rooms are designed for maximum safety and efficiency. The room will feel cool (to reduce infection risk and keep the surgical team comfortable in their sterile gowns), and you'll see various monitors, equipment, and the operating table. The surgical team will position you appropriately for your procedure and ensure you're comfortable.

If you're having general anesthesia, you'll be asked to breathe through a mask and will fall asleep within seconds. For regional anesthesia, you'll be positioned appropriately (often sitting or lying on your side for a spinal) and may feel pressure during the injection. Local anesthesia involves injections in the specific surgical area.

Throughout the surgery, the anesthesia team monitors your heart rate, blood pressure, oxygen levels, and other vital signs continuously. The surgical team follows strict safety protocols, including time-outs to verify the correct patient, procedure, and site before beginning.

What Should You Expect After Surgery?

After surgery, you'll wake up in the recovery room where nurses monitor your vital signs and manage pain. Common experiences include grogginess, nausea, sore throat (from the breathing tube), and pain at the surgical site. Recovery takes hours to weeks depending on surgery type—most patients can go home the same day for minor procedures.

The post-operative period begins the moment your surgery ends and continues until you've fully recovered. Understanding what to expect helps you recognize normal healing versus problems requiring attention. Your surgical team will provide specific instructions, but general principles apply to most surgeries.

In the Recovery Room

You'll wake up in the post-anesthesia care unit (PACU), also called the recovery room. Nurses will monitor your vital signs closely, assess your pain level, and watch for any complications. You may feel groggy, cold, and confused initially—this is normal and improves quickly as anesthesia wears off.

Pain management begins immediately. Your care team will ask about your pain level and provide medications as needed. Don't hesitate to report pain—it's easier to control when addressed early rather than after it becomes severe. You may also receive anti-nausea medication if needed.

If you had a breathing tube, your throat may feel sore and scratchy for a day or two. Drinking cool fluids and using throat lozenges helps. Your voice might also sound hoarse temporarily.

Same-Day Surgery vs. Hospital Stay

Many surgeries are now performed as outpatient or same-day procedures, meaning you go home the same day. You'll need someone to drive you home and stay with you for the first 24 hours. Don't drive, operate machinery, drink alcohol, or make important decisions during this time.

For surgeries requiring hospital admission, your length of stay depends on the procedure type and your recovery progress. ERAS protocols have dramatically reduced hospital stays—what once required a week might now take just 1-2 days. Your care team will assess your readiness for discharge based on pain control, ability to eat and drink, mobility, and specific surgical criteria.

Managing Pain at Home

Some pain after surgery is normal and expected. Your surgical team will prescribe appropriate pain medications and provide instructions for their use. Multi-modal pain management—using different types of medications together—often provides better relief with fewer side effects than relying on opioids alone.

Non-medication strategies also help: ice packs (wrapped in cloth) reduce swelling and pain, proper positioning decreases pressure on surgical sites, and distraction techniques like watching television or listening to music can shift your focus away from discomfort. As you heal, gradually reduce pain medications as comfort allows.

How Should You Care for Your Surgical Wound?

Keep your surgical wound clean and dry for the first 24-48 hours. Follow specific dressing change instructions from your surgeon. Watch for infection signs: increasing redness, swelling, warmth, pus, fever above 38°C (100.4°F), or wound separation. Most surgical wounds heal within 2-4 weeks, though complete tissue remodeling takes months.

Proper wound care is essential for preventing infection and promoting optimal healing. Your surgical site is vulnerable to bacteria in the days after surgery, before the skin fully seals. Following your surgeon's specific instructions reduces complication risk and helps you achieve the best possible cosmetic result.

The First Few Days

Immediately after surgery, your wound will be covered with a sterile dressing. Leave this initial dressing in place for 24-48 hours unless it becomes soaked with blood or your surgeon instructs otherwise. The dressing protects the wound while the initial healing processes begin.

After the first day or two, you may be instructed to remove the dressing and either leave the wound open to air or apply a new dressing. Some wounds are closed with absorbable sutures that don't need removal; others have sutures, staples, or adhesive strips that will be removed at a follow-up appointment, typically 7-14 days after surgery.

You can usually shower 24-48 hours after surgery unless your surgeon specifies otherwise. Let water run over the wound gently but don't scrub it or soak it. Avoid baths, swimming pools, and hot tubs until your wound is fully healed—typically 2-4 weeks. Pat the area dry gently after showering.

Signs of Infection

Surgical site infections occur in about 2-5% of surgeries, making them one of the most common surgical complications. Recognizing infection early allows prompt treatment and prevents serious complications. Contact your healthcare provider immediately if you notice any of these warning signs:

• Increasing redness: Some redness around the incision is normal, but spreading redness is concerning
• Swelling that worsens: Mild swelling is expected, but increasing swelling after 2-3 days suggests a problem
• Warmth around the wound: The area feels notably warmer than surrounding skin
• Discharge: Yellow, green, or cloudy drainage; or foul-smelling drainage
• Fever: Temperature above 38°C (100.4°F)
• Increasing pain: Pain that gets worse rather than gradually improving
• Wound separation: Edges pulling apart or opening up

Promoting Optimal Healing

Good nutrition supports wound healing—protein is especially important. Stay well-hydrated. If you smoke, avoid smoking during recovery; smoking significantly impairs wound healing and increases infection risk. Follow activity restrictions to prevent stress on the wound, particularly for abdominal or joint surgeries.

Once your wound is well-healed, scar care can help optimize cosmetic outcomes. Silicone-based scar treatments (sheets or gels) have the best evidence for improving scar appearance. Protect new scars from sun exposure for at least a year, as UV light can cause permanent darkening. Massage can help soften and flatten scars once the incision is fully closed.

How Long Does Recovery Take?

Recovery time varies dramatically based on surgery type: minor procedures may require 1-2 weeks, while major surgeries can take 6-12 weeks or longer. Factors affecting recovery include your overall health, age, nutritional status, smoking status, and how well you follow post-operative instructions. Most people return to normal activities gradually over several weeks.

Recovery from surgery happens in stages. The immediate post-operative period focuses on managing pain, preventing complications, and beginning to eat and move. The weeks that follow involve gradually returning to normal activities while your body completes the healing process. Understanding realistic expectations helps you plan appropriately and avoid frustration.

Typical Recovery Timelines

Recovery timelines vary significantly based on the type of surgery, surgical approach (minimally invasive vs. open), and individual factors. Here are general guidelines, though your specific situation may differ:

Returning to Activities

Activity restrictions vary by surgery type. In general, avoid heavy lifting (typically nothing over 10 pounds/4.5 kg for the first few weeks) after abdominal or chest surgery. Ask specifically about driving—you'll need to stop any opioid pain medications first, have adequate range of motion, and be able to perform emergency maneuvers safely.

Return to work depends on your job demands. Desk work may be possible within a week for minor surgeries; physically demanding jobs require longer recovery. Your surgeon can provide documentation for your employer if needed.

Exercise should resume gradually. Walking is encouraged early in recovery for most surgeries. Higher-impact activities, swimming, and strength training typically wait until your wound is fully healed and your surgeon approves. Sexual activity can usually resume when you're comfortable, though specific restrictions may apply after certain surgeries.

Factors That Affect Recovery

Several factors influence how quickly you recover:

• Overall health: Chronic conditions like diabetes, heart disease, or lung disease can slow healing
• Age: Older adults may need more time to recover, though age alone doesn't predict outcomes
• Nutrition: Adequate protein, vitamins, and calories support tissue repair
• Smoking: Smoking significantly impairs wound healing and increases complications
• Weight: Obesity increases surgical risks and may slow recovery
• Mental health: Depression and anxiety can impact pain perception and recovery motivation
• Social support: Having help at home facilitates recovery

When Should You Seek Medical Help After Surgery?

Seek immediate medical attention for severe pain not controlled by medications, high fever (over 38.5°C/101.3°F), signs of blood clots (leg swelling, chest pain, shortness of breath), heavy bleeding from the wound, inability to urinate, or wound opening. Contact your surgeon's office for less urgent concerns during business hours.

While most surgical recoveries proceed smoothly, knowing when to seek help is essential for catching complications early. Some symptoms require immediate emergency care; others warrant a call to your surgeon's office. Trust your instincts—if something seems wrong, it's always better to ask.

Contact Your Surgeon For:

• Fever above 38°C (100.4°F)
• Increasing wound redness, swelling, or discharge
• Pain that's worsening rather than improving
• Wound opening or separation
• Nausea and vomiting that prevents eating or drinking
• No bowel movement for 3+ days (especially after abdominal surgery)
• Difficulty urinating or inability to urinate
• Calf pain or swelling (possible blood clot)
• Questions about medications or activity restrictions

Blood Clots (Deep Vein Thrombosis)

Blood clots are a serious concern after surgery, particularly after orthopedic or abdominal procedures, or if you have limited mobility. Clots usually form in the deep veins of the legs (deep vein thrombosis or DVT) and can travel to the lungs (pulmonary embolism or PE), which is life-threatening.

Prevention measures include blood-thinning medications, compression stockings or devices, and early mobilization. Warning signs of DVT include leg pain, swelling, warmth, or redness—usually in one leg. Pulmonary embolism symptoms include sudden shortness of breath, chest pain (especially when breathing deeply), rapid heart rate, or coughing up blood. These require immediate emergency care.