Surgery Check List

Surgery Check List

Once you are scheduled for surgery, please take a few moment to read through the checklist here to reduce the risk of adverse events. Please let us know if any additional information needs to go here. This is constantly updated.

Before the surgery

1. Vacuum the house; Mow the lawn; Rake leaves or do any chores you normally do. You may be out of action for a week. So get this done now. Also vacuuming the house has added benefit in reducing risk of infections.
2. Create a safe room in the house.  This room must have a door that can be secured. Especially useful if you have a pet who has a habit of jumping on you to show affection. You do not want your pet to jump on you when you have drains sticking out of you.
3. Create a sterile dressing kit.  This should have all the dressing, alcohol wipes, iodine and a few medicines at one place. Keep some space in the kit for the bag of medicines you receive after the surgery.
4. Safe room preferably must have large windows with ample sunlight. Sunlight is a good disinfectant. However the windows must also have curtains so that you can sleep peacefully.
5. Make sure house has no loose carpets or other furniture that can make you trip and fall. 
6. Safe room can get air purifier with  HEPA filter. You just do not want any secondary infection.
7. Talk to your family and friends and make a duty roster for them. They will take turns to care for you.
8. Make sure safe room as well as whole house is hygienic. Make sure all the linen on the bed is fresh. 
9. If a TV needs to be moved make sure it is moved now. After surgery you do not have strength to do these things. 
10. Talk to the surgeon's nurse to understand what kind of drains if any will be used post surgery and how to operate them. Get a sample drain and understand how to operate it now. And make sure the family member/friend caring for you knows this as well.
11. Make a list of all the medications; Get a pre-op physical done at our office  so that we can flag any big misses; Just before the surgery some medications may be stopped and new medications may be started. Make sure you have complete list in the Pre-Op note. 
12. Talk to the surgeon's office and get their cell number to contact them in the case of any emergency.
13. Talk to the surgeon's office and get the list of instructions for post operative care following surgery. If you need dressings changed, make sure your home nurse/ care giver is able to do that. 
14. It is important to know who is going to do the surgery. Avoid non physicians and residents. Insist on getting physicians to care for you. Be shameless. This is your life. You do not want any compromise.
15. Provide information to your insurance that certain procedure is planned and they will be getting bills from various entities and ask them to validate if the hospital is in network and ask them to make sure every body who treats you are paid fairly so that the claim can be processed as in network. If insurance pays very poorly that they are not able to find an in network physician ask them to pay usual and customary rates  for out of network physician and ask physicians to waive off charges above usual customary rates. (Physicians never harm the patients and will be glad to work with you .. but not your insurance. So inform the insurance early and often so that they can plan and assist you) 
16. Meet the hospital administration and provide them a letter saying you have asked your insurance to pay the UCR rates for out of network claims and you are requesting hospital to agree for UCR rates. 
17. Make a list of medications you will need after the surgery and if needed get your insurance to agree. Many times we have seen insurance companies denying medicines that are needed. 
18. Book appointment for Post Operative Visit to your primary care. These visits must be done within 7 or 14 days after the hospital discharge so that they can effectively manage your discharge.  During these visits, your primary care can go through your surgery notes and address any emerging situation.  They can also prevent complications by watching the progress and change medications. 
19. Plan your drive back from the hospital to home.  You will not be able to drive. Even if the procedure is small, you may still have difficulty due to anesthesia. So you must have a designated driver to drive you back from the hospital.
20. Plan your car to be trouble free for the ride. Having a flat tire or dead battery that will prevent you from using your car, can spoil your safe journey back home.
21. Clean your car. Use generous disinfectant to clean the seat, sides of the doors.  Remove all the trash from the car. 
22. Plan the route your driver takes while driving you home. As the anesthetics wear out even a small bump can be really painful. So plan on the route that has less acceleration and deceleration and also less bumps. 
23. Buy some Miralax and keep it in your dressing kit ( You can ask if the front office can provide you free of cost during your Pre Op Visit); Pain medications can cause severe constipation and this helps.
24. Get some protein shakes and stock them up (  Front office can provide you coupons if available ). Immediately after surgery for a few days you may not be able to eat regular food and these shakes can be lifesaver.

After the surgery

1.  Follow up with surgeon's office on pre-planned visits.
2. Maintain a picture of sutures or dressing. It helps to see if there is any problem later on. Any infection must be immediately reported.
3. When you are called to surgeon's office for suture removal, make sure a physician or someone designated by the physician removes the sutures.  We know a world class surgeon in Denver who does amazing surgery but hospital where he worked had mid level who  used to yank the drains without cutting a knot the surgeon was putting.  So always make sure only physicians are around you even after the surgery. Mid levels working on their own are not safe.
4. Within 7 days or within 14 days, sooner the better, see your primary care physician and ask for a hospital discharge visit. You will be asked to fill a form and we will go over the procedure notes and address all the open issues. Please remember this visit is really important. We can see many more things what a patient cannot. We have access to surgeon's notes as well we know how to read it. So we fix glaring issues at this stage, all the time. 
5. Ask your surgeon's office for surgery notes and give a copy of the note to your primary care. 
6. If a tumor is removed, ask your primary care to provide an assessment on how efficiently it was done. Many time your primary care can read the surgery notes and see if the margins were correctly taken. 
7. Your medications may need to be reconciled. Please visit your primary care.