Before your surgery in a Hunter New England hospital

Having surgery and staying in the hospital can be stressful and confusing. Our doctors, nurses, and staff are here to help you and keep you safe. It's our job to make sure you understand the health information we give you and to explain the risks and benefits of your surgery and treatment.

We want you to be involved in your care and the decisions that affect you. Don’t hesitate to speak up. If there’s something you don’t understand, need clarified, want repeated, or need more information about, please ask us.

You need to book in at the hospital for your surgery. Your surgeon will discuss your health problem and why they recommend surgery. If you agree to the operation, your surgeon will give you a booklet to fill out and return to the hospital’s admission office.

The booklet includes information about your surgery, health history, and the doctor performing the operation. It also asks questions about your health and medications. You, or someone close to you, need to fill out this booklet to help your doctor plan your surgery and recovery.

Once you return the completed booklet to the hospital admission office, your name will be added to the surgery waitlist.

If you visit a doctor in an outpatient clinic or some private rooms, they might use an eRFA form. If your doctor uses this form, they will explain which documents you need to sign and fill out to book into the hospital.

You may need to take the signed form to the admission office and complete other forms.

Checklist:

• Fill in the 'patient' section of the planned procedure booklet.
• Sign the operation consent form.
• Return the completed booklet to the hospital Admission Office.

Remember, the hospital won’t put your name on the surgery waitlist until you’ve filled in the booklet, signed the consent form, and returned them to the Admission Office.

Over 6 out of 10 Australian adults are overweight or obese. If you are overweight, you have a higher risk of complications during anaesthesia and surgery, such as infections, breathing difficulties, and blood clots in your legs and lungs. Excess weight also increases the likelihood of needing a blood transfusion and can slow down recovery after surgery.

It’s important to talk openly with your medical team about the risks associated with being overweight. Discussing your weight can help improve your chances of a successful surgery and recovery.

Staying active and managing your weight before surgery will help with your anaesthetic, your surgery, and your recovery afterward.

Physical activity

Any physical activity is better than none. Staying active improves fitness, helps control weight, and keeps your muscles and joints healthy before surgery. No matter your age, aim to be active every day.

Here’s what you can do:

• Be active on most days in as many ways as you can.
• If possible, work up to 30 minutes or more of physical activity each day.
• Do activities like the ones below at least twice a week to build strong muscles.

These exercises benefit most people:

• swimming or exercising in water
• stretching and gentle strengthening
• balance exercises
• cycling
• walking at a comfortable pace (talk with your GP first if you are having joint surgery).

Protein is essential for your body to grow and repair muscles and tissues, which is especially important for recovery. Start increasing the protein in your diet as soon as possible.

Include protein-rich foods in every meal and snack. These foods include:

• meat
• chicken
• fish
• dairy (milk, cheese, yoghurt)
• eggs
• nuts
• lentils and legumes (like baked beans).

After surgery, continue to eat healthy foods and drinks to help your body heal and recover. Include foods that boost iron levels, such as lean red meat, chicken, turkey, and seafood. You can also choose iron-enriched foods like cereals and bread.

If you’re struggling to eat due to a poor appetite or have recently lost weight without trying, please inform your GP. Being underweight can lead to problems and may slow down your recovery after surgery.

Increasing your protein intake and using nutritional supplement shakes might help. Ask your GP for advice on how to reach a healthy weight.

Diabetes can create challenges before, during, and after your surgery. Type 2 diabetes is becoming a common long-term health issue in Australia.

Check your risk of developing diabetes.

If your risk is moderate or higher, or if you have a family history of diabetes, talk to your GP. They can do a simple fingertip blood test to check your blood glucose levels.

If you’ve already been diagnosed with diabetes, discuss your risk with your GP and ask them to measure your blood sugar (HbA1c). This test shows if your body is processing sugar properly. High blood sugar levels can increase your risk of infection and other complications after surgery.

Your GP can help you lower your blood sugar if needed. Remember, being overweight raises your chance of developing diabetes.

Anaemia occurs when you have a low number of red blood cells (haemoglobin). It can delay your surgery or slow your recovery afterward.

If you have anaemia, you might feel tired, dizzy, short of breath, have an irregular heartbeat, or even experience chest pain. Many factors can cause anaemia.

Your GP or anaesthetist may order a blood test to check your red blood cell and iron levels before your surgery. If your iron levels are low, you might need to take iron tablets or have an iron infusion. Your GP or anaesthetist will explain the risks and benefits of an iron infusion and arrange it for you if needed.

It's also a good idea to talk to your GP about foods that can boost your iron levels as you prepare for surgery.

Your healthcare team will work to minimise blood loss during your surgery. It’s important to inform your doctors if you:

• have any current or past medical conditions (like kidney or heart problems, or cancer)
• are taking, or have recently taken, blood-thinning medications, including over-the-counter supplements like fish oil.

Your doctors may need to adjust your blood-thinning medication before surgery.

Sometimes, patients may need a blood transfusion to make sure enough blood and oxygen flow to their heart, brain, and other vital organs. A blood transfusion might be needed before, during, or after your surgery.

As part of the consent process, your doctor will discuss whether a blood transfusion may be necessary and will ask for your consent. You have the right to refuse a blood transfusion.

Get more general information about blood transfusions.

About 1 in 10 people in Australia have low iron levels, also known as iron deficiency. Among those having elective surgery, 3 in 10 have low iron or anaemia, which greatly increases the risk of needing a blood transfusion.

Why iron is important

Iron is essential for making haemoglobin, which carries oxygen from your lungs to the rest of your body. If low iron levels or anaemia are left untreated, it can:

• delay your surgery
• increase the likelihood of needing a blood transfusion
• raise the risk of complications
• slow down your recovery after surgery.

Having anaemia before surgery puts you at a higher risk of needing a blood transfusion. Blood transfusions are only used when absolutely necessary, as they are considered an organ transplant and carry inherent risks.

Smoking impacts your surgery and recovery. It strains your heart, increases the risk of blood clots, makes breathing harder, and raises your risk of infection.

Your surgery might be postponed if you don’t follow your doctor’s advice to stop smoking. Quitting now will benefit you, no matter when your surgery is scheduled.

What you can do

There are steps you can take to help cut down or quit smoking. Nicotine replacement therapy (NRT) can reduce cravings and make quitting easier.

NRT is available in patches, gum, sprays, and lozenges, and can be bought at a supermarket. Some types of NRT can be prescribed by your GP.

Using two different forms of NRT, like a patch and gum, can be especially helpful. There are also prescription medications that block nicotine receptors in your brain, making smoking less enjoyable. These medications may not be suitable for everyone.

Talk to your GP about whether NRT or medication is right for you.

Do not drink alcohol for at least 24 hours before your anaesthetic, or your surgery may be cancelled. Alcohol can hinder your body's healing and make the anaesthetic less effective. Heavy alcohol use can also increase the risk of bleeding during surgery.

If you regularly drink 3 or more standard drinks a day, reducing your alcohol intake for at least 4 weeks before your surgery can lower the risk of complications during and after the procedure.

If you regularly take strong painkillers like oxycodone or endone, it can be harder to manage pain after surgery. Reducing how much and how often you use these medicines before your hospital stay will help post-surgery pain medication work better.

Talk to your GP about lowering your dose and usage.

Illicit or recreational drugs can interfere with your anaesthetic during surgery, affect your recovery, and alter how your body responds to pain medication.

Your anaesthetist needs to know if you smoke, drink, or use prescription or non-prescription drugs. This helps them adjust your anaesthetic and pain management for your comfort and safety during and after surgery.

• Sedation: Helps you feel relaxed, more comfortable, and have little or no memory of the procedure.
• Regional: Numbs a specific area of the body (for example: epidurals used in childbirth).
• General: Temporarily stops you from being aware, feeling pain, and forming memories. It induces a carefully controlled state of unconsciousness.

Modern anaesthesia is very safe. About 1 in 10 people feel sick after a general anaesthetic, and about 1 in 100 may have a sore throat. More serious complications, like breathing difficulties or allergic reactions, are much less common but can occur. Your anaesthetist will discuss these risks with you before surgery. Patients with multiple medical conditions may have a higher risk of complications.

General anaesthesia or sedation can be risky for people with untreated sleep apnoea, as they may stop breathing or not breathe properly after surgery. Strong painkillers used after surgery can worsen sleep apnoea. This condition is often linked to snoring and daytime sleepiness. Sleep apnoea is a medical condition, but not everyone who snores has it.

Talk to your GP about sleep apnoea if 3 or more of the following apply to you:

• You snore loudly enough to be heard through closed doors.
• You often feel tired or sleepy during the day, such as falling asleep while driving or talking to someone.
• You have stopped breathing, choked, or gasped during sleep.
• You are being treated for high blood pressure.
• You are overweight (refer to your BMI).
• You are over 50 years old.
• Your shirt collar is larger than 43cm (men) or 41cm (women).
• You are male.

Before your surgery, a specialist doctor called an anaesthetist will assess your health and discuss your anaesthetic plan. If you have health or anaesthetic risks, or if you'll stay in the hospital overnight after surgery, you may meet the anaesthetist before your surgery date. This can happen during a pre-admission clinic appointment, either in person or by phone.

The anaesthetist will help you prepare for surgery by discussing how to get as healthy as possible. They will also explain your anaesthetic options, including the risks and benefits. During surgery, your anaesthetist will stay with you to monitor your heart and breathing, provide oxygen, and make sure you are safe and comfortable. After surgery, they will take you to the recovery room and manage your pain control.

Inform your anaesthetist about:

• all your medical conditions, regardless of how minor or well-managed they are
• all the medications you take, most can be continued as usual, but some may have special instructions
• any use of blood-thinning medication before surgery, including any changes or discontinuation
• your weight and fitness level
• whether you smoke, drink alcohol, or use recreational drugs.