What you must tell your surgeon before surgery

What you must tell your surgeon before surgery

Fourteen details that affect bleeding, infection, anaesthesia and healing risks.

Even a technically successful operation can have complications if medicines, an infection or a chronic condition are not taken into account beforehand. Share the following information in advance rather than on the day of admission. A risk factor does not automatically mean that surgery will be cancelled: the doctor needs time to assess it and make a safe plan.

1. Medicines that affect blood clotting

Give the medicine's name, dose, time of the last dose and reason for taking it. It is particularly important to report medicines used after coronary stenting or for atrial fibrillation, blood clots, artificial heart valves or coronary artery disease:

Apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa);

Warfarin;

Clopidogrel (Plavix), ticagrelor (Brilinta), prasugrel;

Acetylsalicylic acid: aspirin, Cardiomagnyl, Thrombo ASS and equivalent products.

Important. Do not stop these medicines on your own. The interruption interval depends on the medicine, kidney function, bleeding risk, type of anaesthesia and risk of thrombosis. Stopping antiplatelet treatment without advice is particularly dangerous after a recent stent.

Doctor's comment. The most useful outcome of the consultation is a written schedule: what to take, what to pause, the date of the last dose and when to restart.

2. Any sources of infection

Tell the surgeon even if symptoms seem minor:

A painful tooth, swollen or bleeding gums, or unfinished dental treatment;

A throat infection, a flare-up of sinusitis, fever or cough;

Burning or pain when passing urine, or frequent urges to urinate;

Pustules, boils, ulcers, fungal infection, scratch marks or skin wounds;

Recent COVID-19, flu or another infectious illness.

Active infection is particularly important in joint replacement because an implant will be present. However, an abnormal urine result without symptoms is not the same as an infection: routine treatment of asymptomatic bacteriuria before non-urological surgery has not demonstrated benefit. Assessment depends on symptoms and the procedure.

3. Injections into a joint before surgery

Give the exact date, joint, side and substance injected. This applies particularly to Diprospan, Kenalog and other glucocorticoids, but also report hyaluronic acid, PRP, cellular products and any other injections.

A 2023 meta-analysis including 370,019 knees found increased odds of periprosthetic joint infection following a steroid injection less than three months before surgery: OR 1.26 (95% CI 1.06–1.50). Another meta-analysis of hip and knee replacement reported an OR of 1.39 (95% CI 1.04–1.87) for an interval shorter than three months. The data are mainly observational, so the operating surgeon determines the interval; the rule cannot automatically be applied to every substance and joint.

Doctor's comment. If joint replacement is already being discussed, agree any new joint injection with the surgeon first. “It was just an injection” is not enough: the name and date matter.

4. Do not shave the surgical area yourself

Shaving with a razor causes irritation and small skin injuries. The CDC advises against shaving the area of the planned incision at home. If hair interferes with surgery, staff will remove it using clippers according to the clinic's protocol.

5. Diabetes

Report the type of diabetes, recent glucose and HbA1c results, episodes of hypoglycaemia and your full medication list. Poor glucose control is associated with infection, impaired healing and cardiovascular complications. No single HbA1c value automatically permits or rules out every operation. CPOC guidance treats a value above 69 mmol/mol (8.5%) as suboptimal control and a reason to optimise treatment when the clinical situation allows. Insulin, SGLT2 inhibitors and GLP-1 medicines require a separate plan.

6. Blood pressure and heart conditions

Report poorly controlled blood pressure, recent hypertensive crises, chest pain or pressure, increasing breathlessness, fainting and new irregular heartbeats in advance. Also give the dates of any heart attack, stroke, stent placement, pacemaker implantation or heart valve surgery. New or unstable symptoms require assessment before an elective procedure.

7. Osteoporosis and bone quality

Describe fractures after minor injuries, loss of height, long-term steroid use and osteoporosis treatment. When indicated, the doctor assesses FRAX, requests bone densitometry and orders tests including vitamin D, calcium and kidney function. Bisphosphonates, denosumab and anabolic treatments have different indications; do not start or stop them on your own before joint replacement.

8. Smoking

Smoking impairs tissue blood supply, lung function and healing. According to the WHO, stopping approximately four weeks or more before surgery is associated with fewer postoperative complications. If less time remains, stopping is still worthwhile: do not wait until the operation.

9. Excess weight and major changes in body weight

Obesity is associated with a higher risk of infection and several other complications, but body mass index alone does not determine the outcome. Also report unintentional weight loss, poor appetite and difficulty eating. An extreme diet immediately before surgery may cause muscle loss and protein deficiency; weight reduction should be gradual and agreed with the treating team.

10. Allergies and severe reactions

List allergies to antibiotics, pain medicines, anaesthetic agents, antiseptics, adhesive dressings and latex. Give not only the substance but also the reaction: rash, swelling, difficulty breathing, low blood pressure or another symptom. Also report a confirmed metal allergy, although skin sensitivity to jewellery alone does not determine implant choice.

11. Previous operations

List all operations on the relevant limb and any plates, screws, rods or other hardware still present. Report previous postoperative infection, wound breakdown, prolonged drainage, repeat wound treatment and problems with bone healing.

12. Chronic conditions and treatments that suppress immunity

Describe kidney and liver disease, rheumatic and autoimmune conditions, immune deficiency, cancer treatment and transplantation. Specifically name glucocorticoids and immunosuppressants. Do not stop them yourself: abrupt withdrawal of some hormonal treatments is dangerous, and the timing of biologic therapy depends on the medicine and disease activity.

13. Supplements, vitamins and herbal products

Report all supplements, including omega-3, ginkgo, ginseng, St John's wort, high doses of garlic and vitamin E. Evidence for bleeding risk varies between supplements, but interactions with anticoagulants, anaesthesia and other medicines are possible. A doctor should decide whether a temporary pause is needed after checking the ingredients and dose.

14. A complete list of all medicines

Bring a medication list rather than just a list of diagnoses, using the format “name — dose — times per day — reason prescribed”. Include:

Tablets and capsules; injections, including diabetes and weight-loss medicines; inhalers and nasal sprays; eye drops; ointments, gels and patches; vitamins, sports supplements and herbal products.

What else your anaesthetist and surgeon should know

Anaemia and deficiencies. Report anaemia and deficiencies of iron, vitamin B12 or folate.

Nutrition. Poor appetite, protein deficiency and marked unintentional weight loss matter.

Sleep apnoea. Report the diagnosis or symptoms such as loud snoring and pauses in breathing during sleep. If you use CPAP, tell the team about your device.

Blood clots. Report previous deep vein thrombosis, pulmonary embolism or clotting disorders.

Blood transfusions. Report transfusions and any unusual reactions to them.

Anaesthesia. Severe nausea, difficulty waking up, allergy or another unusual response to anaesthesia in you or a close relative is important.

S. aureus and MRSA. Report known carrier status and any previous decolonisation.

Vaccination and recent infection. Surgical timing is assessed individually.

Doctor's comment. The most dangerous information is not “bad” information but information the doctor does not know. One detail shared in time can change the anaesthetic plan, infection prevention or medication schedule.