Akron General Surgery Guide

Pre-surgical Testing

Your doctor may determine, based on your health history, that you need pre-surgical testing. His or her office will call to schedule the appointment and will indicate the tests you may need before your surgery. If you need to cancel or reschedule, call your doctor’s office.

Take all prescribed medications as you normally would the day of your pre-surgical testing office visit. You may eat and drink the morning of this office visit. If you are bringing a lab work requisition from a provider other than your surgeon 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.

We will need to know more about your health history. Please complete our online Health History Form.

For all pre-surgical testing and surgery registration, call 330.344.6152, Monday - Friday, 8 a.m. – 4:30 p.m.

A registered nurse will call you within 24 hours of your surgery date 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, Monday - Friday, 8 a.m. – 4:30 p.m.

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, 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.

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. No 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.
• Women of childbearing age 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.

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.

Before your surgery

You will be taken to the Pre-Surgical Unit, where:

• You will be asked to change into a gown.
• 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.

Because of limited space, we ask that there be no more than two visitors per patient in the Pre-Surgical Unit. In order to protect our patients, caregivers and community and to prevent the spread of COVID-19, we are making changes to our visitation policy.  For the most current visitation guidelines, visit our website.

During your surgery

Once you go into surgery your visitors will be instructed to return to the Surgery Welcome Center. While you are in surgery, we will keep your family and/or friends in the Surgery Welcome Center informed. Visitors are always welcome in the Surgery Welcome Center or the main lobby, but, because of limited space, we ask that there be no more than two visitors per patient at any one time in the Pre-Surgical Unit.

We will notify your family when you are ready for discharge from the Post Anesthesia Care Unit (PACU) or when you are transferred to your room.

Anesthesia

Following your intake assessment, a board-certified anesthesiologist will then explain your anesthesia options. Together, you will then review your health and anesthesia history, as well as the type of anesthesia to be used during your surgery, including:

• General anesthesia causes you to be asleep (unconscious) during the surgical procedure.
• Regional anesthesia (nerve block, epidural and spinal) causes the area of the body, which includes the surgery site, to be numb. Nerve blocks can also provide pain relief for many hours after surgery.
• Local anesthesia is performed by the surgeon at the surgical site.
• Monitored anesthesia care (MAC) combines local anesthesia at the surgical site (administered by the surgeon) and significant intravenous sedation and monitoring provided by the anesthesia personnel.

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

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

IMAGERY

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

MUSIC

1. Get in a comfortable position.
2. 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.