Preparing for Surgery

Thirty-five million Americans undergo surgery every year, most of them women. Many women will face a recommendation for surgery that involves their reproductive system, typically called gynecologic surgery. For example, hysterectomy-surgery that removes the uterus and sometimes other parts of the reproductive tract-is the second most common gynecologic surgery after Cesarean section.

Facing surgery can be a frightening experience fraught with questions, doubts, and uncertainties. However, most surgeries are elective, meaning that you decide if surgery is the best option for you and elect to have the procedure. This decision process often gives you needed time to prepare, which is an important step. Research suggests that women who prepare mentally and physically for surgery have fewer complications, less pain, and recover more quickly than those who don't prepare.

Within 20 years of the invention of anesthesia in the 1860s, operations were developed for conditions ranging from appendicitis to uterine fibroids. Enthusiasm for gynecologic surgery was especially intense. In 1890 it was fashionable to invent operations to "correct" the position of the uterus. Hysterectomies were becoming increasingly popular, as well. By 1925, open abdominal surgery on women's reproductive organs had become routine.

Today, the trend in gynecologic surgery is toward less invasive techniques that don't require surgeons to cut into the abdomen with large incisions. Also, new, faster-acting anesthetics have been developed that have fewer side effects than traditional anesthetic agents.

Settings for surgery have changed, too. Less than a decade ago, having surgery meant being admitted to the hospital a day ahead and discharged a week later. Today, more than half of all surgeries, including many gynecological procedures, are done on an outpatient basis. Outpatient surgery refers to operations that do not require an overnight hospital stay. Instead, the surgery is performed at a hospital ambulatory surgery center, or health care professional's office, and you return home in less than 24 hours.

Generally, outpatient, or ambulatory surgery, is appropriate for simple procedures that can be done in 60 to 90 minutes and don't require a person to be closely monitored afterwards. Outpatient surgery offers several advantages over surgery that requires hospitalization, such as:

a lower risk of infection after surgery

a shorter recovery period

recovery at home

fewer delays and shorter waiting times

lower cost

less disruption of your schedule

However, if a large incision has to be made, or if the risk of complication is high, same-day surgery may not be an option. Outpatient surgery is not for everyone. Women with chronic conditions such as diabetes, heart disease, or high blood pressure (hypertension), or who are otherwise at risk for complications that could require hospitalization, might not be eligible.

Same-day surgery also puts more responsibility on the patient to complete the necessary preoperative tests, manage pain medications, keep incisions clean, and follow through with postoperative care on their own. A woman who has small children to care for at home may be unwilling or unable to take on the added responsibility and may not be a good candidate for same-day surgery. If you face a recommendation for surgery, be sure to consider which type of setting will work best for you.

Such advances in surgery may make it more convenient, but they haven't necessarily made it less stressful. Hormones released in response to stress can cause symptoms ranging from headaches to high blood pressure. Hormones can also weaken the immune system and disrupt the body's ability to manage pain and infection.

Preparing Emotionally
Surgery also has an emotional impact. A woman who has heard that a hysterectomy will ruin her sex life or leave her tired for months, for example, may become depressed, fearful, or angry with her body. For some women, the anticipation of being hospitalized and separated from family members makes coping difficult. Even simple procedures done in a doctor's office can provoke a strong reaction.

Some experts advocate preparing for surgery through a series of relaxation therapies: deep breathing, positive thinking, and visualization-imagining or mentally seeing-a positive outcome from surgery and a quick recovery period, for example.

Preparing Physically
While emotional preparation is a necessary, often-overlooked step, preparing physically is also very important for a successful surgical outcome. In the weeks before your surgery, you should:

stop smoking and avoid excessive alcohol

eat a well-balanced diet including plenty of vitamin C-rich foods, which may help promote tissue healing

avoid aspirin or other aspirin-like medications that interfere with blood clotting for seven days prior to your surgery

exercise regularly to build energy, and maintain strength

ready your home, including preparing food and rearranging furniture if necessary

If you have children to take care of, arrange for someone else to take care of them while you are in the hospital.

If you decide to have surgery, discuss the following with your health care professional:

determine when elective surgery can be scheduled, taking into consideration your job and family commitments. Sometimes it is not possible to know the exact time of the surgery until the business day before the actual date

learn which routine laboratory tests may be needed, which may include x-rays, blood tests, and urine tests, and an electrocardiogram

ask if you need to change the schedule and dosage of any medications you are taking

if you are diabetic, discuss how to keep your insulin levels under control during the immediate pre-operative period when you are not eating

Legal Considerations
Once you've decided on surgery, had the necessary tests done, and prepared mentally and physically, you'll be asked to sign a consent form. Now may also be a good time to consider donating blood for your surgery, if you wish to, and drawing up advance directives. These instructions communicate your health care plans if you cannot speak for yourself in the future.

There are two kinds of advance directives: a living will and a health care proxy. States differ in the directives they recognize. Discuss your wishes with your health care professional and your lawyer. Sample directives are available from the American Association of Retired Persons, the local health department, state medical associations, or a hospital admissions office.

A health care professional is required to have a detailed discussion with you before your surgery so that you are fully informed when making the decision whether to have it. This is called obtaining your "informed consent" to have the procedure. The informed consent process should include discussion of:

the nature of your condition

the nature of the proposed surgery

the risks of the proposed surgery

the alternatives to the proposed procedure and the risks and benefits of these alternatives

Consent forms differ from one health care professional to another, and may include permission for additional procedures to be performed if needed. Ask to sign the consent form several days in advance to avoid being confronted with a list of risks immediately before surgery, which can create anxiety. Do not sign the consent form until you understand and feel comfortable about what is being done. Don't let this part of the process feel rushed. Ask questions if you need to.

Before surgery you may also be asked to sign a form allowing a blood transfusion to be performed, if necessary. Normally, blood donated to the Red Cross four to six weeks in advance of your surgery is shipped to the hospital a few days before your surgery. However, you can also donate your own, called an autologous blood donation. Or you can ask family members or friends with the same blood type to donate units of blood for you. You'll need to inform your surgeon whom you have chosen to donate blood for your use.

If you're considering autologous blood donation:

ask your surgeon if you are likely to need blood and if so, how much

consider taking iron supplements to rebuild your blood supply before surgery

Call the Red Cross and ask about fees, insurance coverage, and about freezing your blood if your surgery is delayed.

Financial Considerations
Familiarize yourself with the extent of your medical benefit plan before your operation so that you will know what portion of the costs will be your responsibility. Your physician's office staff may be able to help you find out how much your medical benefit plan will cover. If your medical benefit plan will not pay all of the anticipated costs, and you cannot afford the difference, then discuss this situation with your surgeon to see if you can work out a solution that is mutually acceptable.

Some procedures and some health plans require "pre-authorization" before your operation. Become familiar with your insurance plan requirements to avoid unpleasant surprises after your surgery.

Understanding Pain
Knowing what to expect after surgery is as important as knowing what to expect beforehand. Pain is an inevitable part of surgery. Pain is the body's way of sending a warning to the brain that it has been damaged and needs attention. Although a normal reaction to surgery, pain can interfere with recovery by:

causing you to suppress coughs, which can lead to fluid in the lungs and pneumonia

slowing the return to normal digestion

preventing you from getting out of bed, raising the risk of blood clots

increasing stress, depression, and anxiety

There are several ways to relieve pain after surgery. Narcotics, such as morphine and codeine may be prescribed for severe pain following surgery. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or other non-narcotic pain relievers may also be used, either as liquids or solids. Local anesthetic injections or anesthetic creams may help prepare your body for a procedure or relieve pain afterwards. Ask the surgeon or anesthesiologist to discuss these options with you beforehand. Other non-medical approaches to pain management can be very successful. These may include:

relaxation techniques

applying heat or ice to the surgical site

massage and stretching exercises

When preparing for surgery, discuss with your health care professional what possible pains to expect after your procedure and how to best manage any possible symptoms.