Preparing for your surgery

Preoperative assessment is a ‘health check’ to ensure that you’re fit and ready for surgery. You will be given a date for your surgery, sometimes it is necessary to alter this planned surgery date following your pre-operative assessment. You will be notified of any changes, either by letter or telephone.

It is important that you follow any instructions which have been given to you as part of preparation for an operation or procedure. These instructions are provided at your consultation or as part of the pre-operative assessment process.

Your health after your pre-operative assessment

If you become unwell prior to your operation date and are therefore not fit to have your surgery, it is vital that you ring and inform us on 0121 685 4362. You will then be sent a new date for your operation.

It is also important that you contact us if your medication changes prior to your admission.

Cough, cold, sore throat

If you develop a cough or cold symptoms, please contact the nurse in the Pre-Operative Assessment Clinic for advice on 0121 685 4362.

Skin

For certain types of surgery, it is important that your skin is not broken or damaged in any way, e.g. leg ulcers, rashes, or inflamed cuts, as these may be a source of infection. If you develop any skin concerns, please contact the nurse in  Pre-Operative Assessment Clinic for advice on 0121 685 4362.

Waiting well for your surgery

There are many things you can do to help manage your physical and mental wellbeing. Even small changes can make a big difference:

• Do as much moderate exercise as your pain will allow, but in particular make sure that you do pre-surgery exercises you have been given. Ensuring that you eat healthily in the days/weeks before your operation should help you to recover more quickly.
• Stop smoking (including e-cigarettes) – your chest needs to be clear for your anaesthetic.
• Drink alcohol only in moderation.

If you have been given a waiting well card, you can scan the QR code for more information. Alternatively, you can visit www.roh.nhs.uk/supporting-services/waiting-well

If you require a paper version of this card, please let us know.

Skin preparation before your operation

Shower or bath on the morning of your operation, you should also wash and dry your hair.

Do not apply any skin creams,  lotions, deodorant or other products to the area of the operation because this will result in the sterile drapes not sticking. 

Do not shave for 2 days prior to your surgery date anywhere near the operation site, because this increases the risk of infection.

If you have been provided with Octenisan wash by the hospital prior to your surgery, it is important that this is used properly and for the number of days advised by the clinical team. The Octenisan wash should be applied to wet skin using a clean, damp washcloth in the same way normal soap/bodywash is applied – do not add water to dilute the wash. Once applied the Octenisan wash should be left on for 1 minute before rinsing off with clean water. Octenisan should also be used to wash hair in the same way as normal shampoo whilst following the above instructions.

Keeping warm reduces the risk of surgical site infection. During cold weather make sure that you are warm on arrival for your surgery. Hospital staff will take measures to keep you warm during your surgery and hospital stay but please ask for extra blankets if you feel you are cooling down.

Eating and drinking on the day of your admission

Unless you have been advised differently, you should stop eating and drinking six hours before your admission time, apart from clear fluids which you are encouraged to drink freely.

Your admission letter will be sent to you with a leaflet containing additional information about your admission, please take the time to read this. 

On arrival, you will be offered a standard cup of water to drink.

You can then follow the ‘sip till send’ policy which allows you to drink up to one standard cup of water an hour until you are sent for surgery. 

Drinking enough water will help your wound to heal and will reduce your risk of pressure ulcers and blood clots.

It’s not safe to operate on people who are dehydrated, if you haven’t drank enough water your surgery may be cancelled.

Anaesthesia

Preparing yourself for anaesthetic

It is difficult to separate the risks of anaesthesia from the risks of the operation and your general health. The risks to you depends on whether you have any other illnesses or other risk factors, such as smoking and being overweight;

• If you smoke, giving up for several weeks before the operation reduces the risk of breathing problems and improves healing of the tissues. If you cannot stop, cutting down will help
• If you are very overweight, reducing your weight will minimise anaesthetic risk

What will happen before my surgery?

You will meet your anaesthetist before your operation and they will ask you questions about your health, previous anaesthetics and usual medicines and will need to check your answers to other questions. They may need to examine your chest with a stethoscope and examine your neck and mouth. Please ask questions and tell them any worries you may have.

You will receive clear instructions when to stop eating and drinking before your operation. It is very important to follow these, or your operation may be delayed or cancelled.

Types of anaesthesia during surgery

There are two main types of anaesthesia, general anaesthesia and local anaesthesia. They are often combined.

General anaesthesia

A general anaesthetic is a combination of drugs which are given to make you completely unconscious. During a general anaesthetic you do not feel anything and will not be aware of what is going on around you. It is uncommon for general anaesthesia alone to be used for hip surgery. A sedation technique may be used instead of a general anaesthetic. This makes you relaxed and sleepy during the operation, but you are not unconscious.

Modern general anaesthetic is very safe. There are some common side effects and some less common side effects:

Common side effects or complications:

• Sore throat
• Feeling sick
• Shivering
• Headache

Less common side effects or complications:

• Chest infection
• Muscle pain
• Damage to the teeth, lips or eyes
• Excessive drowsiness

Serious complications related to general anaesthesia are rare but include life threatening allergy to drugs and breathing difficulties and cardiac issues such as heart attack and stroke.

Regional anaesthesia

Regional anaesthesia uses local anaesthetics which are drugs that have a numbing effect. They stop you feeling pain and other sensations in part of your body but on their own do not cause any loss of consciousness.

Types include the following:

1.    Spinal anaesthetic

• Local anaesthetic is injected near to the nerves in your back
• You go numb from the waist downwards
• You feel no pain but you remain conscious
• If you prefer, you can also have drugs that make you feel sleepy and relaxed (sedation). You are likely to have little memory of the time during which you have been given sedation

2.    Epidural

• This is similar to a spinal anaesthetic. It involves inserting a very fine plastic tube into your back, through which the local anaesthetic is given. It can be used to continue pain relief for several days after your surgery
• General surgical risks

Thromboses and emboli (blood clots)

• Blood clots in the leg veins (deep vein thrombosis) and blood clots on the lungs (pulmonary embolus) are a risk associated with joint replacement surgery.
• The simplest way of reducing this risk is early mobilisation (exercises and walking).
• Whilst in hospital you may also be prescribed medication, usually in the form of injections, to reduce the risk of clot formation.
• Patients already receiving anti-coagulant therapy will be assessed and advised accordingly.

Reducing the risk of infection in hospital

What can you do to help?

• Keeping your hands and body clean is important when you are in hospital. Take personal toiletries and specific skin care preparations if appropriate
• Wash your hands with soap and water or clean hands with an alcohol based gel before eating food
• Wash your hands after visiting the toilet or using commode or urinal
• Do not touch your dressing or surgical site. Visitors must not touch your dressing
• Speak up if you see that a health care worker has not washed or cleaned their hands
• Ask your visitors to wash their hands on arrival to the ward
• Inform a nurse if your dressing becomes wet or loose
• If you visit the bathroom or toilet, and you are concerned that it does not look clean, report this immediately to the nurse in charge of the ward. Request it be cleaned before you use it, and use an alternative in the meantime
• Always wear something on your feet when walking around the hospital
• If your visitors are feeling unwell, or have had diarrhoea or vomiting in the last 48 hours, they should stay away from the hospital to prevent the spread of infection
• Visitors should avoid sitting on the bed and use the chairs provided at the bedside 
   

Superficial infection

• You will not be discharged from hospital unless the appearance of the wound is satisfactory. Where possible, the dressing will stay on until the removal of your clips or stitches. After discharge, if you have any concerns about your wound, please call the ward you were discharged from.

Deep infection

• A deep infection of the joint most often starts when bacteria gains access to the tissues at the time of surgery and great lengths are taken in theatre to reduce the risks of this happening. Operations are carried out in an ultraclean air theatre and sterile clothing is worn by the surgical team. You may be given antibiotics to prevent infection at the time of surgery.
• Despite all the precautions taken, infections can still occur. An early deep infection (within the first six weeks) may rarely occur and this would require further treatment.
• Remember infection is a serious complication. If you develop any new redness around the wound or if the wound leaks after leaving hospital, it is important that you call us on 0121 685 4308, 8:00 – 16:00, Mon – Fri, or follow the advice given to you on your discharge letter.

Recovering at home

A shorter stay in hospital reduces infection risk and promotes early mobility. This improves your circulation, reduces your risk of blood clots and promotes a faster recovery. You can sleep in your own bed, eat preferred meals and be in charge of your pain killers.

When preparing for your surgery, please also remember to prepare for your discharge from hospital:

• Consider who can take you home on the day when you have been discharged.
• Plan to have someone at home or someone that can stay with you to support you if needed for a day or two.

More information about wound care can be found in our ‘After your Operation’ leaflet on the website: www.roh.nhs.uk.

You will also receive a paper copy of this on your discharge from hospital.

Learning Disabilities & Autism

If you have a diagnosis, or are awaiting a diagnosis of a learning disability and/or autism, we have a learning disability & autism team that can support you.

We can offer additional support including the 'Easy Read' leaflet & 'Hospital Passport'

Please let a member of the Pre-Operative team know if you would like support, or feel free to contact the team directly on the details below:

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Telephone: Sally Wilson (Liaison Nurse)- 07917 090 805
Telephone: Rosie Roberts (Liaison Nurse)- 07341 123 385

More information and support

If you need more information about your Pre-Operative Assessment please call 0121 685 4362, Monday – Friday.
If you need general information, please contact PALS on 0121 685 4128.