This article is one in a series of patient safety topics that provide simple, easy-to-follow checklists for patients to follow as they prepare for orthopaedic surgery.
Before your orthopaedic surgery, get an up-to-date list of all your medications—along with their dosages—from your primary care doctor. Share the list with your surgeon during one of your preoperative visits and with your anesthesiologist on the day of your surgery. Your preoperative nurse should also place a copy of the list in your chart.
In most cases, your surgeon will instruct you not to eat or drink anything after midnight the night before surgery. This means that you will skip some of your medications on the day of surgery. Your surgeon may recommend, however, that you take your heart and blood pressure medications on the morning of your surgery with just a few sips of water.
Listed below are the primary medications that can affect your surgery. Be sure to tell your medical team about all the medications you are taking.
In most cases, heart medications should be continued on the day of surgery and throughout hospitalization. If you have had a heart attack, coronary artery disease, or chest pain with exercise, a preoperative consultation with your cardiologist will help prepare you for surgery. Sometimes, an additional heart medication, called a beta blocker, may be added before your surgery to decrease your risk of heart problems during and after surgery.
Blood Pressure/Anti-Hypertensive Medications
Blood pressure medications are usually continued on the day of surgery and following surgery. Even if you are not supposed to eat or drink on the day of surgery, your surgeon may recommend that you take your blood pressure medicine with a sip of water.
It is a good idea to have your blood pressure checked a few days before surgery so that your primary care physician can adjust your medication dosage if your blood pressure is too high or too low. If your blood pressure is not well controlled by the day of surgery, your surgery could be delayed.
Blood thinners such as aspirin, Coumadin®, Xarelto®, or Pradexa® should be stopped before surgery. Your surgeon will tell you how far ahead of time to stop your medication. In some cases, you will be placed on a shorter acting blood thinner that can be taken up until a few hours before surgery.
You will restart blood thinners after surgery as soon as your surgeon feels it is safe, usually within 24 hours. Because bleeding during and after surgery increases your risk of wound infections and postoperative anemia, it is important to safely manage blood thinners.
If you are taking insulin or oral diabetic medications, tell your surgeon. Surgery can cause increased stress and higher blood sugar, so your insulin dose may need to be adjusted on the day of your surgery and during recovery. In addition, some oral diabetic medications should be discontinued before you are given anesthesia.
If you have recently taken a course of steroids or are on long-term steroid therapy, make sure to tell your surgeon and anesthesiologist. Steroid medications, such as Prednisone®, should be continued both during and after surgery. Most likely, your surgeon will give you additional doses at the start of your procedure. This is because long-term steroid therapy suppresses the adrenal gland, which manufactures the steroids your body needs. Inadequate steroid levels during surgery can lead to hypotension or low blood pressure.
If you have an inflammatory condition such as rheumatoid arthritis, lupus or Crohn's disease, or you are a transplant patient, you may be taking an immunosuppressant medication. Immunosuppresents can slow wound healing after surgery. Your surgeon will tell you if should continue to take your medication or stop it for a period of time before your surgery.
In addition to prescription medicines, tell your surgeon about any over-the-counter dietary supplements you may be taking. Some supplements interfere with medications that may be needed after your surgery, and taking them can lead to complications.
The American Academy of Orthopaedic Surgeons
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Rosemont, IL 60018