Treatment
Preparing for Orthopaedic Surgery: Medication Safety Checklist
Before your orthopaedic surgery, get an up-to-date list of all your medications — along with their dosages — from your pharmacy or primary care doctor. Add to that list all of the supplements, vitamins, and/or over-the-counter medications that you take regularly.
Share the list with your orthopaedic surgeon during one of your preoperative visits and with your anesthesiologist on the day of your surgery. Your peri-operative team (the nurses and staff who help coordinate your surgery) should also place a copy of the list in your chart and electronic medical record (EMR).
In most cases, your surgeon will instruct you not to eat or drink anything after midnight the night before surgery. This means that you might skip some of your medications on the day of surgery. Your surgeon may recommend, however, that you take certain medications (such as heart and blood pressure medications) on the morning of your surgery with just a few sips of water.
Preoperative Medication Safety Checklist
Listed below are the most common types of medications that can affect your surgery. Some others may not be listed here, so be sure to tell your medical team about all the medications, vitamins, and supplements you are taking.
Heart Medications
In most cases, your heart medications should be continued on the day of surgery (with a sip of water) and throughout your hospitalization.
If in the past you have had a heart attack, coronary artery disease, or chest pain with exercise, a preoperative consultation with your medical doctor or cardiologist will help guide you most safely through surgery.
Sometimes, additional heart medications, such as a beta blocker, may be added to the medications you already take 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 your orthopaedic surgery (with a sip of water) and then during your recovery as prescribed. Even if you are not supposed to eat or drink on the day of surgery, your care team may recommend that you take your blood pressure medicine (with a sip of water only).
It is a good idea to have your blood pressure checked within a few days of your surgery. This enables your prescribing physician to adjust your medication dosage if your blood pressure is too high or too low, so you can tolerate the added stress of your surgery. If your blood pressure is not well controlled, your orthopaedic surgery could be delayed.
Blood Thinners/Anti-Coagulants
Blood thinners such as aspirin, Coumadin®, Xarelto®, or Eliquis® should typically be stopped before surgery. Your care team will tell you how far ahead of time to stop your medication.
In some cases, you will temporarily be placed on a shorter-acting blood thinner that can be taken up until a few hours before surgery. Each type of orthopaedic surgery may have unique instructions around blood thinners. Talk to your orthopaedic surgeon and peri-operative team about what will be needed for you. These decisions may be made with input from both your orthopaedic surgeon and medical doctor.
You will typically restart blood thinners during your recovery as soon as your surgeon feels it is safe. Because bleeding during and after your orthopaedic surgery increases your risk of wound infections and postoperative anemia, it is very important to safely manage blood thinners.
Diabetic Medications
It is very important to tell your orthopaedic surgeon and peri-operative team if you are taking insulin, GLP-1 injectables, weight loss, or oral diabetic medications.
- Surgery can cause increased stress and raise your blood sugar, so your insulin dose may need to be adjusted on the day of your surgery and during recovery.
- GLP-1 injectables, or semaglutides, may decrease your stomach emptying and create a risk of vomiting during surgery.
- Some oral diabetic medications may interact with the medications used by the anesthesiologist.
- Blood sugar levels directly influence healing and infection risk.
Careful control of your diabetes will be directed by your healthcare team to decrease those risks and help you safely recover.
Steroid Medications
If you have recently taken a course of steroids or are on long-term steroid therapy, make sure to tell your orthopaedic surgeon and anesthesiologist.
Steroid medications, such as Prednisone®, are typically continued both during and after surgery. Most likely, your anesthesiologist 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 flares of inflammation and hypotension (low blood pressure).
Immunosuppressant Medications
You may be taking an immunosuppressant medication or chemotherapy if you:
- Have an inflammatory condition (e.g., rheumatoid arthritis, lupus, or Crohn's disease)
- Are a transplant patient
Immunosuppressants can increase the risk of infection or slow healing after surgery.
Your rheumatologist, oncologist, and orthopaedic surgeon will tell you if you should:
- Continue to take your medication as prescribed, or
- Stop it for a period of time before and, sometimes, after your surgery
Dietary Supplements and Vitamins
In addition to prescription medicines, tell your surgeon about any over-the-counter dietary supplements or vitamins you may be taking. Some supplements increase the risk of bleeding or may interfere with medications that may be needed after your surgery, and taking them can risk your safety.
Conclusion
A variety of medications are used to address health issues on a daily basis and to relieve pain and other symptoms during and after orthopaedic surgery.
Using a medication safety checklist before your procedure and informing your orthopaedic surgeon and surgical team about all of the medications you take can help to ensure a smoother, safer road to recovery.
Last Reviewed
January 2025
Contributed and/or Updated by
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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.