Copyright 2014 American Academy of Orthopaedic Surgeons
Preparing for Surgery: Health Condition Checklist
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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.

Many health conditions can affect the outcome of your surgery. For elective orthopaedic procedures, you will have time to plan ahead and prepare for surgery, both physically and emotionally.

It is important to be in the best health condition possible before your surgery. Work with your primary care physician and your surgeon to make sure any chronic conditions — such as diabetes or high blood pressure — are under control. Talk to your doctor about how to safely improve your strength and endurance to ensure a smooth recovery.

Being physically ready for surgery will improve your chances for a good result, and reduce your risk for surgical complications.

Managing Your Medical Conditions

Diabetes Mellitus

If you are diabetic, talk to your doctor about the best way to get your blood sugar under control before surgery. Uncontrolled diabetes can slow the healing of your surgical wound, and put you at an increased risk for infections, and kidney and heart problems.

Be sure to tell your surgeon if you are taking insulin. Surgery can cause increased stress to your body and higher blood sugar, so your insulin dose may need to be adjusted. Your surgeon should also know if you take oral medications for diabetes. Some of these should be discontinued before you are given anesthesia.

Anemia

Anemia (low red blood cell count) increases your risk of cardiac and wound complications during surgery. Before surgery, your red blood cell count should be checked. If it is low, your doctor will work with you to increase it before surgery. In addition, discuss with your surgeon the plans for managing any blood loss that may occur after surgery.

Opioid/Narcotic Drug Use

If you regularly use opioid or narcotic medication to control your orthopaedic pain, it can make it harder to control pain after surgery. Chronic opioid or narcotic use before surgery can lead to complications, including pneumonia, and withdrawal problems like seizures and confusion. Talk with your doctor about how to decrease or stop your opioid medication before surgery. Consulting a pain specialist may be necessary to help you control your opioid use.

Be sure to discuss all your opioid and narcotic medications with your surgeon and primary care physician so that they can determine an appropriate plan for managing your pain both before and after surgery.

Varicose Veins, Leg Swelling, and Blood Clots

Surgery and postoperative immobility increases the risk of blood clots forming in your legs. Blood clots can cause pain and swelling, and may even travel to other parts of your body, such as your lungs.

Be sure your surgeon knows if you or a family member has a history of blood clots, or problems with varicose veins or leg swelling. For some operations, blood thinners or compression devices for your legs are used to help prevent blood clots.

High Blood Pressure/Hypertension

If you have high blood pressure, talk to your surgeon and primary care physician about your medications. In the days before your surgery, check your blood pressure several times. It should be well-controlled with medication by the day of surgery. If it is not controlled, your surgery could be delayed.

Getting into Shape for Surgery

Smoking

Smokers are at a greater risk for serious complications after surgery than nonsmokers. These complications include wound infections, pneumonia, heart attack, and stroke.

Smoking can also slow down or prevent broken bones from healing, and can delay the bone healing needed for successful joint replacement and fusion surgeries.

To improve your chances for a successful surgical outcome, stop smoking for at least a month before surgery, and try not to resume for several weeks afterward, or not at all.

Obesity

Overweight and obese patients are at increased risk of medical and surgical complications, including wound infections, pneumonia, blood clots, and heart attack.

Talk to your surgeon or primary care physician about losing weight before surgery to reduce your chance of complications.

Diet and Nutrition

A healthy diet with proper nutrition is important for your recovery. Both before and after surgery, you should follow a balanced diet that includes adequate protein and vitamins.

Your surgeon or primary care physician may recommend blood tests to check your nutritional health. Correcting your diet and improving your nutritional health can decrease your risk of wound infection and slow healing after surgery.

Physical Conditioning

If you have limited your activities because of chronic orthopaedic pain, you may have lost physical strength and endurance. Ask your surgeon about a physical activity and conditioning program to help you regain strength before surgery. The better shape you are in before surgery, the sooner you will recover your strength afterward.

Sleep Apnea

Sleep apnea is a medical condition that causes irregular breathing when you are sleeping. Older and heavier people are more likely to have this condition. Undiagnosed sleep apnea increases your risk of cardiac complications during recovery from your surgery.

If you suspect you have sleep apnea, ask your primary care physician or surgeon about preoperative testing and treatment for the condition.

Depression

A history of depression or low energy that requires medical treatment can result in an increased dependence on opioid pain medication after surgery and a slower recovery. If you have symptoms of depression before surgery, seek treatment so that you are physically and mentally prepared for your procedure and recovery.

Memory Impairments and Movement Disorders

Memory loss and movement disorders, such as Parkinson's disease, may put patients at a greater risk of postoperative falls or confusion.

Having a friend or family member stay with you during your hospitalization and recovery can help you stay mentally clear and more comfortable with your healthcare team and hospital environment. Family and friends can also help you navigate your surroundings and support you to prevent falls.

Tell your surgeon about all the medications you may be taking for your movement disorder because some may reduce your need for postoperative pain medication.

Staph Infections

One in four surgical patients have staphylococcus (staph) bacteria growing in their nasal passages without any symptoms. These bacteria greatly increase your risk for postoperative staph infection. Tell your surgeon if you have a history of staph infections. Testing can be done to check for the presence of staph before surgery. If the bacteria is found, you will be provided a special antibiotic ointment to apply preoperatively to reduce your chance of wound infection.

Surgical Site Skin Preparation

Clean and healthy skin is vital for proper wound healing. Avoid shaving the skin in the area of your planned incision for 2 weeks before surgery. On the day of surgery, wash the area with an over-the-counter chlorhexidine soap several times. This soap can be used when you return home to help keep your hands clean and protect your wound.

Last reviewed: March 2014
AAOS does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopaedic advice or assistance should consult his or her orthopaedic surgeon, or locate one in your area through the AAOS "Find an Orthopaedist" program on this website.
Copyright 2014 American Academy of Orthopaedic Surgeons
Related Articles
Guía del Paciente para la cirugía segura (Patient Guide to Safe Surgery) (http://orthoinfo.aaos.org/topic.cfm?topic=A00720)
Patient Guide to Safe Surgery (http://orthoinfo.aaos.org/topic.cfm?topic=A00563)
Patient Safety (http://orthoinfo.aaos.org/topic.cfm?topic=A00684)
Patients Are Important Members of the Healthcare Team (http://orthoinfo.aaos.org/topic.cfm?topic=A00271)
Preparing for Surgery: Medication Safety Checklist (http://orthoinfo.aaos.org/topic.cfm?topic=A00718)
Surgical Safety Checklist: Steps Your Healthcare Team Takes (http://orthoinfo.aaos.org/topic.cfm?topic=A00716)
OrthoInfo
The American Academy of Orthopaedic Surgeons
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Rosemont, IL 60018
Phone: 847.823.7186
Email: orthoinfo@aaos.org

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