PREPARING FOR ELECTIVE SURGERY

Preparing for a planned surgery (also called elective surgery) includes selecting a surgery center and surgeon to perform the procedure, scheduling the surgery, undergoing pre-surgical testing, meeting with health care professionals and the surgical team, receiving education about the procedure, receiving and following all of the appropriate preoperative instructions, and signing a consent form. Preparing for surgery helps the patient understand what to expect before surgery and ensures the patient is physically and psychologically ready for the surgery.

Most patients go to the surgery center or hospital the same day as the scheduled surgery; thus, many of the steps involved in preparing for surgery will take place from one to four weeks before the scheduled surgery. Many surgeries are performed on an outpatient basis, which means that the patient goes home the same day as the surgery.

Selecting a surgeon and surgery center
SURGEON
A surgeon, along with a multi-disciplinary team of surgical specialists, will perform the surgery. The surgeon should be board certified by the American Board of Surgery, as well as certified by the medical specialty board or boards related to the type of surgery performed. Certification from a medical specialty board means that the surgeon has completed an approved educational training program (including three to seven years of full-time training in an accredited residency program). Certification also includes an evaluation, including an examination that assessed the surgeon’s knowledge, skills, and experience necessary to perform high-quality patient care in that specialty.

There are 24 certifying boards recognized by the American Board of Member Specialties (ABMS) and the American Medical Association (AMA). Most of the ABMS boards issue time-limited certificates, valid for six to 10 years. This requires physicians to become recertified to maintain their board certification—a process that includes a credential review, continuing education in the specialty, and additional examinations. Even though board certification is not required for an individual physician to practice medicine, most hospitals require that a certain percentage of their staff be board certified.

The letters FACS (Fellow of the American College of Surgeons) after a surgeon’s name are a further indication of a surgeon’s qualifications. Those who become Fellows of the American College of Surgeons have passed a comprehensive evaluation of their surgical training and skills; they also have demonstrated their commitment to high standards of ethical conduct. This evaluation is conducted according to national standards that were established to ensure that patients receive the best possible surgical care.

A surgeon’s membership in professional societies is also an important consideration. Professional societies provide an independent forum for medical specialists to discuss issues of national interest and mutual concern. Examples of professional societies include the Society of Thoracic Surgeons (STS) and the American College of Physicians–American Society of Internal Medicine (ACP-ASIM).

To find information about a surgeon’s qualifications, the patient can call a state or county medical association for assistance. A reference book is also available: The Official ABMS Directory of Board Certified Medical Specialists that lists all surgeons who are certified by approved boards. This publication also contains brief information about each surgeon’s medical education and training, and it can be found in many libraries.

SURGERY CENTER
The surgeon will arrange for the procedure to be performed in a hospital where he or she has staff privileges. The patient should make sure the hospital has been accredited by the Joint Commission on Accreditation of Healthcare Organizations, a professionally sponsored program that stimulates a high quality of patient care in health care facilities. Joint Commission accreditation means the hospital voluntarily sought accreditation and met national health and safety standards. There is also an accreditation option that is available for ambulatory surgery centers.

Selecting a surgery center that has a multi-disciplinary team of specialists is important. The surgery team should include surgeons, infectious disease specialists, pharmacologists, and advanced care registered nurses. Other surgical team members may include fellows and residents, clinical coordinators, physical therapists, respiratory therapists, registered dietitians, social workers, and financial counselors.

Choosing a surgery center with experience is important. Some questions to consider when choosing a surgery center or hospital include:
• How many surgeries are performed annually and what are the outcomes/survival rates of those surgeries?
• How do the surgery center’s outcomes compare with the national average?
• Does the surgery center offer treatment for a patient’s specific condition? How experienced is the staff in treating that condition?
• What is the center’s success record in providing the specific medical treatment or procedure?
• Does the surgery center have experience treating patients the same age as the inquiring patient?
• Does the surgery center explain the patient’s rights and responsibilities?
• Does the surgery center have a written description of its services and fees?
• How much does the patient’s type of treatment cost at this surgery center?
• Is financial help available?
• Who will be responsible for the patient’s specific care plan while he or she is in the hospital?
• If the center is far from the patient’s home, will accommodations be provided for caregivers?
• What type of services are available during the patient’s hospital stay?
• Will a discharge plan be developed before the patient goes home from the hospital?
• Does the hospital provide training to help the patient care for his or her condition at home?

Scheduling the surgery
Depending on the nature of the surgery, it may be scheduled within days or weeks after the surgery is determined to be the appropriate treatment option for the patient. The patient’s surgery time may not be determined until the business day before the scheduled surgery. The patient may be instructed to call the surgical center to find out the time of the scheduled surgery.

The time the patient is told to report to the surgery center (arrival time) is not the time when the surgery will take place. Patients are told to arrive at the surgery center far enough in advance (usually about two hours prior to the scheduled surgery time) so they can be properly prepared for surgery. In some cases, the patient’s surgery may need to be rescheduled if another patient requires emergency surgery at the patient’s scheduled time. The patient should ask the health care providers if the scheduled surgery will be performed on an outpatient or inpatient basis. Outpatient means the patient goes home the same day as the surgery; inpatient means a hospital stay is required.

Pre-surgical testing
Pre-surgical testing, also called preoperative testing or surgical consultation, includes a review of the patient’s medical history, a complete physical examination, a variety of tests, patient education, and meetings with the health care team. The review of the patient’s medical history includes an evaluation of the patient’s previous and current medical conditions, surgeries and procedures, medications, and any other health conditions such as allergies that may impact the surgery. Pre-surgical testing is generally scheduled within one week before the surgery.

The patient may find it helpful to bring along a family member or friend to the pre-surgical testing appointments. This caregiver can help the patient remember important details to prepare for surgery.

After attending the surgical consultation, the patient may desire to seek a second opinion to confirm the first doctor’s treatment recommendations. The patient should check with his or her insurance provider to determine if the second opinion consultation is covered.

Meeting with the surgical team
During the surgical consultation, the patient meets with the surgeon or a member of the surgeon’s health care team to discuss the surgery and other potential treatment options for the patient’s medical condition. At some time before the surgery, the patient will meet with other health care providers, including the anesthesiologist, nurse clinicians, and sometimes a dietitian, social worker, or rehabilitation specialist.

Patient education
The surgical team will ensure that the patient understands the potential benefits and risks of the procedure as well as what to expect before the procedure and during the recovery. Patient education may include one-on-one instruction from a health care provider, educational sessions in a group setting, or self-guided learning videos or modules. Informative and instructional handouts are usually provided to explain specific pre-surgical requirements. Some surgery centers offer services such as guided imagery and relaxation tapes, massage therapy, aromatherapy, or other complementary techniques to reduce a patient’s level of stress and anxiety before a surgical procedure.

Guided imagery is a form of focused relaxation that coaches the patient to visualize calm, peaceful images. Several research studies have proven that guided imagery can significantly reduce stress and anxiety before and after surgical and medical procedures and help the patient recover more rapidly. Guided imagery and relaxation tapes are available at many major bookstores and from some surgery centers. The patient may be able to listen to the tapes during the procedure, depending on the type of procedure being performed.

Preoperative instructions
Preoperative instructions include information about reserving blood products for surgery, taking or discontinuing medications before the surgery, eating and drinking before surgery, quitting smoking, limiting activities before surgery, and preparing items to bring to the hospital the day of surgery.