Akron General Surgery Guide

Insurance Coverage

Many insurance companies require pre-authorization for hospital admissions. Please make sure we have the most current and complete insurance information. Confirm with your insurance company that all necessary paperwork has been completed prior to your admission.

Be sure to bring your insurance card and prescription drug card with you the day of your surgery.

Please attend your Admitting Interview prior to your day of surgery, to ensure we have the most up-to-date insurance information.

If you have questions about your insurance approval, please call the pre-authorization customer service office at 216.444.4811. The office is open Monday through Friday from 8 a.m. – 4:30 p.m.

Cleveland Clinic Akron General will bill your insurance carrier for the charges associated with your stay. Any balance not covered by your insurance company will be billed to you.

Pre-Anesthesia Testing

Based on your health history, your surgeon may determine that you need Pre-Anesthesia Testing. The reason for this visit is to perform a comprehensive review of the patient's past medical history, assess their current health status and obtain any additional testing required based on anesthesia guidelines. We will also identify any potential anesthesia problems or contraindications to the planned procedure.

Your surgeon’s office will call to schedule your pre-anesthesia testing appointment and will indicate the tests you may need before your surgery. If you need to cancel or reschedule, call your surgeon’s office.

Take all prescribed medications as you normally would the day of your Pre-Anesthesia Testing visit. You may eat and drink the morning of your Pre-Anesthesia Testing visit. If you are bringing a lab work requisition from a provider other than your surgeon in to be completed on the same day, please check with that provider to verify whether you should or should not eat or drink for their lab work. Also, please let the registration caregiver know that you have an additional lab requisition. You DO NOT need to schedule a lab appointment via MyChart for Pre-surgery lab work. You will be checked in for lab work after your Pre-Anesthesia Testing appointment.

A registered nurse will call you within 24-48 hours of your Pre-Anesthesia Testing to review important information with you, including:

Your health history.
Medications.
Pre-operative instructions.

If you are unavailable at the time of the call, please return the call to 330.344.7776. The office is open Monday through Friday from 8 a.m. – 4:30 p.m.

Questions

Pre-Anesthesia Testing - Call 330.344.7776. The office is open Monday through Friday from 8 a.m. – 4:30 p.m.
Surgery registration - Call 330.344.6152.

Preparing for Surgery

Information your doctor needs to know about before your surgery:

Any illness, including sore throat, flu, elevated temperature, or if you have been exposed to a contagious disease.
Changes to your skin, especially near the incision site, including cuts, scratches, insect bites, animal bites, rashes and poison ivy.
Any medications you take daily, including prescriptions, aspirin, blood thinners, insulin and arthritis medications.
If you have diabetes and/or an insulin pump, you will need to discuss day-of-surgery instructions with the doctor who manages your diabetes.

Home-going information you need to know before your surgery:

For your personal safety, you will not be allowed to drive or take a taxi, Uber or Lyft home alone following your surgery. Please make arrangements for a responsible adult to drive you or accompany you home in a taxi, Uber or Lyft. That person should remain in the Surgery Welcome Center during your surgery in order to receive timely updates regarding your status, including discharge or admission information.
Your ride should be available to take you home immediately following your discharge.
For your safety, arrange for someone to stay with you for 24 hours after surgery. Your surgery may be canceled if no one is available to stay with you.
If you are having surgery on your knee or foot, it is very important to ask your doctor if you will need crutches post-operatively. This needs to be addressed prior to the day of your surgery.
For your personal safety REMOVE all jewelry and piercings before coming to the hospital. If you have piercings you cannot remove yourself, please discuss this with your surgeon and make arrangements for removal prior to your surgery date. Forever jewelry should also be removed.

Advance directives

For your own peace of mind, we encourage the completion of Advance Directives, which outline your wishes for life-sustaining treatments, and include a Living Will and Durable Power of Attorney for Health Care. Please bring a completed copy to be included in your medical record. If you have questions or need further assistance, please call 330.344.6880 or visit akrongeneral.org to learn more.

Understanding Your Surgery

Make sure you understand what will happen before, during and after your surgery. Research has shown that patients who are informed can better work with their doctors to make the right decisions. Together, you and your doctor should review the possible benefits and risks involved in the surgery you are scheduled for.

Day prior to your surgery

For your safety, please:

DO NOT drink alcoholic beverages or use any illegal substances for 24 hours before your surgery. Alcohol/illegal substances may cause an undesired reaction when mixed with anesthesia or other drugs. If you appear under the influence of alcohol or illegal substances your surgery may be canceled.
DO NOT smoke before or after your surgery. Smoking may cause anesthetic problems and increase carbon monoxide in the blood stream. Nicotine also interferes with healing.
DO NOT eat or drink after midnight the night before your surgery unless otherwise instructed by your doctor (this includes water, coffee, gum, mints and lozenges).
If applicable, complete any pre-operative prep as instructed by your doctor.
Practice coughing and deep breathing exercises and pain control techniques.

Day of Your Surgery

What to bring with you

Your driver’s license or a photo ID, as well as your insurance card and prescription pharmacy card
Inhalers, if you use them
A CPAP or BIPAP machine, if you use either
Your glasses and glass case
DO NOT bring any valuables (cash, checks, credit cards, cell phones, jewelry, etc.) with you

The morning of your surgery

Continue to take all your scheduled medications, as instructed, with only a sip of water. You may take prescribed pain medication, if needed. If you have any questions, please ask your doctor for additional instructions.
Perform your normal morning routines such as showering and brushing your teeth.
Wear loose-fitting clothes.
DO NOT wear cologne, perfume, skin lotions or makeup.
DO NOT wear wigs, hairpins, contact lenses, false eyelashes, dentures, partial plates, jewelry or piercings are permitted. If you have piercings that you can’t remove yourself, please discuss this with your physician prior to your surgery date.
Menstruating females and females who have had a period in the last 12 months, will be required to bring the first voided urine on the day of surgery for pregnancy testing. You may use a clear leak-proof container labeled with your name. Bring the container of urine with you to the pre-surgical unit on the day of your surgery.

Arriving at the hospital

Please plan to arrive TWO hours before your scheduled surgery time. Endoscopy patients should arrive 60 minutes prior to scheduled procedure time. This allows enough time for pre-surgical registration, anesthesia personnel and to be prepared for your surgery.
Enter the hospital through the main entrance and proceed directly to the Surgery Welcome Center. As you enter the Surgery Welcome Center and sign in with the receptionist, we may ask for your photo ID and insurance information. As surgery times and preparations for surgery vary with each patient, you may be taken out of order in which you registered.
When checking in for surgery, the receptionist will ask for the name of a family member or friend that status updates will be shared with.

Unfortunately, emergencies or cancellations cannot be predicted and can affect your estimated surgery time. If this happens to you, we appreciate your patience. We will make every attempt to keep you and your family informed of changes as they occur.

Please remember

Due to the anesthesia/sedation used, and for your safety, you will not be permitted to drive or work for 24 hours.
On the day of your surgery, a responsible driver will need to be in attendance to assist in your discharge process and to return you home.
For your safety, taxi cabs, Uber and senior transportation, ARE NOT acceptable responsible drivers unless you are accompanied by another responsible person that will stay with you. This is for your safety and therefore, NO EXCEPTIONS will be made.
Please do not bring any valuables with you on the day of surgery.

Before your surgery

Only you, the patient, will be taken to the Pre-Surgical Unit, where:

You will be asked to change into a gown.
Upon arrival, a urine sample pregnancy test is required for menstruating females and females who have had a period in the last 12 months.
You will have a lengthy interview about your current health status and allergies.
Your current medications will be reviewed. You will need to provide the date and time you last took your medications. Please leave all medications at home unless instructed to do otherwise from your physician.
Your temperature, pulse and blood pressure will be taken, along with an interview assessment. A nurse will review any allergies and any medications you are taking.
Dentures, glasses and other prostheses will be removed just before you’re taken to the operating room and returned to you in the recovery room.
The nurse may start an intravenous line to administer fluids and medication during your surgery.
Multiple checks will be performed to confirm your surgical site. If your surgery involves the left or right side, your doctor will initial the correct operative site with a marking pen.
While you are in the perioperative area, you may be asked several times to state your name, date of birth and what type of surgery you are having. Do not be alarmed by this. It is our way of ensuring your safety.
Once the patient admission process is complete, we will make every effort to bring one to two family members or friends into Pre-Surgery to stay with you until you go into surgery.

In the Operating Room

You are the most important person in the operating room, and your care, comfort, safety and satisfaction are our priority. Many people are concerned about undergoing surgery, so your nurse will answer any questions you may have and will be with you throughout the procedure.

You will be asked questions in the Operating Room:

Patient identification is verified by your name and date of birth.
You will be asked to verify the surgical procedure to be performed followed by confirmation of the marked surgical site.

You may notice a lot of activity in the operating room. The lights may seem bright and the temperature cool. Warmed blankets are available for your comfort upon request. Please notify a nurse or surgical personnel if you are uncomfortable.

An additional aspect of our safety culture is called the “time out.” In this safety measure, we confirm the following before surgery begins:

The correct patient.
The correct side and site marking.
The correct procedure.
The correct position on the operating table.
The correct implants, special equipment, and x-rays (when applicable).

Surgery Welcome Center

To follow the patient’s progress throughout surgery, Surgery Welcome Center digital screen displays real time surgery updates. To protect your privacy, your name will not be shown on the screen. You will receive your own personal identification number that you can share with your family or friend. They will use this number to monitor milestones such as when you enter the Operating Room (OR), the start and end of the procedure and your transfer into our recovery areas such as the Post Anesthesia Care Unit (PACU) or the Recovery Room. Once a patient is transferred out of the PACU, the status of the patient is no longer displayed on the digital screen.

Family and/or a friend should notify the staff at the Surgery Waiting Desk if they leave the area at any time during the surgery.

We strongly suggest young children stay at home due to long waiting periods.

Family members may wish to bring a book or other materials from home to help pass the time. Bringing a sweater or jacket is recommended as rooms may be cool.

Amenities at Akron General

Public WiFi access is available.
Ground Floor Amenities
- Cafeteria
Second Floor/Main Lobby Amenities
- Pharmacy
- Gift Shop
- Panera Bread

Anesthesia

In the operating room, your surgeon may administer your anesthetic, if you are having a procedure performed under "local" anesthesia only. Otherwise, an Anesthesia Care Team will care for you the entire time you are in the operating room. The Anesthesia Care Team consists of a staff physician anesthesiologist with either an anesthesia resident or Certified Registered Nurse Anesthetist (CRNA). The Anesthesia Care Team ensures you have both a smooth and safe anesthetic. They will constantly monitor your vital signs, including your heart rate and rhythm, blood pressure, and amount of oxygen in your blood. Should you require special monitoring for your safety, these monitors may be placed either before or after you enter the operating room. The type of anesthesia you receive will depend upon the surgery you are having and your state of health. All of your questions and concerns will be addressed in a conversation prior to ensuring a safe start to your procedure.

General Anesthesia

This is the most common type of anesthesia performed for surgery. You will be made unconscious during your surgery with the use of intravenous medications. When your surgery is finished, the medications are stopped, and you will begin to awaken from anesthesia.

Regional Anesthesia

This type of anesthesia is similar to what you may experience at the dentist's office. With regional anesthesia, only the area of the body on which surgery is being performed is numbed. Spinal or epidural anesthesia is occasionally used for surgery of the legs or for some gynecologic and urologic procedures. Peripheral nerve blocks may be used for arm, shoulder, and foot or knee surgery. This entails placing medicine around a nerve or group of nerves to block the feeling at the location where the surgeon is operating. It can be used for anesthetic purposes during the surgery as well as for a method of pain control after your surgery. If this method is chosen, it can be done either prior to going into the operating room or after your surgery in the recovery room. An advantage to having a nerve block prior to surgery is that patients usually need less anesthetic medicine during their surgery which can decrease the chance of side effects happening.

Plane (TAP, Rectus, PECS) Blocks

Plane blocks involve injection of local anesthetic medication in a specific layer between your muscles. This area contains many nerves that supply sensation from your chest (PECS) or abdomen (TAP/RECTUS), so numbing these nerves can reduce pain from your surgery, typically lasting 1-2 days. Plane blocks will not stop all pain but will work with other medications to help control your surgical pain. A plane block is done by a physician anesthesiologist during your surgery so you will wake up more comfortably.

Monitored Anesthesia Care (MAC)

During this type of anesthetic, the Anesthesia Care Team gives you medications intravenously to make you drowsy and comfortable while monitoring your vital signs. Your surgeon provides “local" anesthesia to the site of surgery. MAC anesthesia covers light sedation, deep sedation and everything in between. The depth of sedation will be determined by your Anesthesia Care Team depending on your surgery, your comfort, and your health.

Local Anesthesia

Occasionally, your surgeon may prefer to perform a procedure in the operating room that requires only local anesthesia. This involves numbing only a specific area and will be administered by your surgeon.

After Your Surgery

Following surgery, you will be taken to the Post-Anesthesia Care Unit (PACU). Specially trained nurses will monitor your progress in recovering from the immediate effects of your surgery and anesthesia. Oxygen is routinely used upon arrival to the PACU. You will be asked to cough and deep breathe. You will also be asked to rate your pain on a scale of 0-10, with 0 being no pain and 10 being severe pain. Reporting pain as a number helps the doctors and nurses know how well your treatment is working and whether changes should be made.

Your pain relief and anesthesia medications will vary depending upon the type of procedure you have had, the anesthesia used and how you respond to pain medication. Pain medications in small doses will be given to keep you comfortable, but may cause some nausea. Although absence of pain may not be possible, we want to make you as comfortable as possible. Each patient responds differently to anesthesia. Outpatient recovery time is typically around 90 minutes, but please do not be alarmed if you remain in the PACU longer than the average time. The PACU nurse may call your family spokesperson after surgery to explain your condition and status.

You will be given medications during your surgery that may affect your ability to remember. Please be sure to discuss any questions you have with your doctor.

To protect the privacy of all patients, there are no routine visiting hours in the PACU. Visiting can be arranged on an individualized basis.

If You Are Admitted to the Hospital

The admission process

If you are being admitted to the hospital, your family may join you on the nursing unit once your nurse has checked you into your room and completed your assessment. This may take up to 45 minutes to complete.

It is important that your healthcare provider know exactly what medications you are taking. Do not take any medications or supplements that you have brought from home while you are a patient in the hospital, unless your doctor has approved of the use.

For your convenience, family and friends can reach a patient room or other Cleveland Clinic Akron General phone number by calling 1.800.221.4601.

Same Day Discharge

If you are having outpatient surgery and going home the same day, you will be discharged from the PACU when you meet the discharge criteria set by your anesthesiologist and doctor. If you wish, you may have something to drink and crackers to eat as you recover.

During the discharge process, you will be given homecare instructions and any prescriptions ordered by your doctor.

One family member may join you to listen to discharge instructions. No children under the age of 14 will be permitted in the PACU. You will be discharged to your car from the main entrance of the hospital.

If you have any medical concerns post-operatively, please call your doctor listed on your discharge sheet. If you cannot reach your doctor, you can call the Emergency Department at 330.344.6611.

If you have a medical emergency, call 911 or go to the nearest Emergency Department.

Surgical Site Infections

What is a surgical site infection (SSI)?

A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about 1 to 3 of every 100 surgical patients.

Some common symptoms of surgical site infections are:

Redness and pain around the area where you had surgery.
Drainage of cloudy fluid from your surgical wound.
Fever.

Can SSIs be treated?

Yes. Most surgical site infections can be treated with antibiotics. The antibiotics given to you depends on the bacteria (germs) causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection.

What are some of the things that hospitals are doing to prevent SSIs?

To prevent SSIs, doctors, nurses and other health care providers:

Clean their hands and arms up to their elbows with an antiseptic agent just before the surgery.
Clean their hands with soap and water or an alcohol-based hand rub before and after caring for each patient.
May remove some of your hair immediately before your surgery using electric clippers if the hair is in the same area where the procedure will occur. They should not shave you with a razor.
Wear special hair covers, masks, gowns and gloves during surgery to keep the surgery area clean.
Give you antibiotics before your surgery starts. In most cases, you should get antibiotics within 60 minutes of the start of your surgery. The antibiotics should be stopped within 24 hours of the completion of your surgery.
Clean the skin at the site of your surgery with a special soap that kills germs.

What can I do to help prevent SSIs?

Before your surgery:

Tell your doctor about other medical problems you may have. Health problems such as allergies, diabetes and obesity could affect your surgery and your treatment.
Quit smoking. Patients who smoke get more infections. Talk to your doctor about how you can quit smoking before your surgery.
Do not shave near where you will have surgery. Shaving with a razor can irritate your skin and make it easier to develop an infection.

At the time of your surgery:

Speak up if someone tries to shave you with a razor before surgery.
Ask why you need to be shaved and talk with your surgeon if you have any concerns.
Ask if you will get antibiotics before surgery.

After your surgery:

Make sure that your healthcare providers clean their hands before examining you, either with soap and water or an alcohol-based hand rub. If you do not see your healthcare providers clean their hands, please ask them to do so.
Family and friends who visit you should not touch the surgical wound or dressings.
Family and friends should clean their hands with soap and water or an alcohol-based hand rub before and after visiting you. If you do not see them clean their hands, please ask them to do so.

What do I need to do when I go home from the hospital?

Before you go home, your doctor or nurse should explain everything you need to know about taking care of your wound. Make sure you understand how to care for your wound before you leave the hospital.
Always clean your hands before and after caring for your wound.
Before you go home, make sure you know who to contact if you have questions or problems once you get home.
If you have any symptoms of an infections, such as redness and pain at the surgery site, drainage or fever, call your doctor immediately.

If you have any additional questions, please ask your doctor or nurse.

This information is provided and endorsed by the Society for Healthcare Epidemiology of America, Infectious Disease Society of America, American Hospital Association, Association for Professionals in Infection Control and Epidemiology, Inc., Centers for Disease Control and The Joint Commission.

Going Home

Home care instructions

We care about your safety and comfort after surgery and urge you to follow these instructions regarding your recovery, unless otherwise instructed by your doctor. If you have any questions, please refer to your discharge instructions or call your doctor.

To control your pain, your doctor may give you a prescription.
Progress gradually from fluids to solid foods.
Do not drink alcoholic beverages or use illegal substances for at least 24 hours after surgery.
Take deep breaths to keep your lungs clear.
Move around according to your instructions.
Do not drive or operate machinery for 24 hours after surgery or if taking narcotic pain medications.
Do not make important decisions or sign any important documents within 24 hours after surgery.

Additionally, you will receive a courtesy follow-up phone call the next business day after your surgery to see how you are doing and if there are any questions you might have. If no one answers the phone, for your privacy, we will not leave a voice message. There is no need to return our call, unless you have any questions or concerns.

Pain control

After surgery, we may not be able to stop all your pain, but we will help you to be as comfortable as possible.

Other helpful pain reduction techniques

RELAXATION TECHNIQUES

Get in a comfortable position.
Breathe in slowly while counting to three.
Breathe out slowly while counting to three.
Continue breathing in and out in same manner.

IMAGERY

Get in a comfortable position.
Imagine you are in a place you have found to be relaxing (e.g. beach, mountains).
Breathe in and out slowly while picturing this in your mind.

MUSIC

Get in a comfortable position.
Listen to “easy listening” music or your favorite type of music with your eyes closed.

Coughing and deep breathing

Coughing and deep breathing will help prevent pneumonia, decrease pain, improve the oxygen in your blood and remove the anesthetic from your body. You will be asked to take three or four deep breaths followed by one cough, 10 times every hour on the day of your surgery. Deep breathing and coughing can be accomplished in a sitting or lying down position.

Breathe out normally.
Clasp your hands over your abdomen.
Breathe in until you feel your abdomen push out.
Breathe out slowly.
Rest a few seconds.
Repeat three to four times then cough one to two times.
Relax and breathe normally.
Repeat technique 10 times every hour.

Activity

You may wake up with pumps on your feet or inflatable stockings on your legs after your surgery. These help pump blood from your legs back to your heart. Movement and walking will decrease the chance of blood clots forming in your legs. We will teach you how to do ankle pumps. When lying down, point your toes on both feet toward your chin and stretch them out by pushing them away from your chin. Do this 10 times an hour. Flex your knees. Do not lie in one position or cross your legs.

Financial arrangements

Your doctor is a member of the hospital’s medical staff and will supervise your care. Your doctor will arrange for your tests, medications, diet and completion of a history and physical. Your doctor may call in other specialists for consultation or assistance.

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