Microsoft word - pre-op surgery instructions(2).doc

INFORMATION FOR SURGERY
PATIENT NAME: __________________________ PRIOR TO THE DATE OF SURGERY YOU MUST:

_______ Have your pre-op testing completed 4 weeks prior to surgery (no more than 30 days
prior). Contact your Family Physician regarding where to have your testing done
and to schedule an appointment. (You do not have to fast prior to the testing
appointment). Make sure to provide the facility with your family physician’s name
and fax number, so that they can submit test results prior to medical clearance
appointment.
_______ Have an examination by your primary care physician to obtain medical clearance at least 3-4 weeks prior to surgery date (no more than 30 days prior). If not received
at least 1 week prior your surgery may be cancelled.
_______ If you have a history of cardiac/heart issues, please inform one of our Nurses. Please make sure to contact your Cardiologist for cardiac clearance.
_______ If you are taking any anti-inflammatory (ALEVE, ADVIL, MOTRIN,
CELEBREX, NAPROSYN, DICLOFENAC, ETODOLAC, MOBIC, DAYPRO
or any medication containing Aspirin, Ibuprofen, VITAMIN E or OMEGA 3 you
must discontinue this medication 10 days prior to the day of surgery. (Unless you
are directed otherwise by our office or your primary care physician’s office).
_______ If you are taking PLAVIX or any other platelet inhibitor you MUST stop this
Medication at least 7 days prior to the date of your surgery. (Unless you are
directed otherwise by our office or your Cardiologist).

_______ If you are taking a blood thinner such as COUMADIN, HEPARIN, LOVENOX you
MUST discontinue these per your PCP or cardiologist’s recommendations.
_______ If you are taking a prescribed blood thinner, you must inform you’re pre-scribing physician of your upcoming surgery date and our office must be informed of the instructions you receive from your prescribing physician.
_______ All diabetic medications containing Metformin (a biguanide) should be held 24-48
hours before surgery and also held the day of surgery. The policy of UPMC Passavant requires Metformin be held 24 hours before surgery and the day of surgery. Metformin has many names:
-Metformin, Riomet, Glucophage, Fortamet or Glumetza.

Combo drugs with Metformin:
ACTOPLUS Met, Avandamet, Glucovance or Metaglip.
______ In general: blood pressure meds (except straight diuretics), seizure meds, GERD meds, pain meds, parkinson meds all can be taken AM of OR with sips of water.**
But please verify this with your PCP**
_______ All weight loss supplements, including over-the-counter and prescription Meridia, need to be held 2 weeks prior to surgery. ADMISSION/HOSPITAL INSTRUCTIONS:

_______ Eat a good dinner, evening snack and drink lots of fluids the day prior to your surgery
so that you are well hydrated and nourished on the day of surgery.
_______ DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT (12 A.M.) THE
NIGHT BEFORE SURGERY unless your family doctor advises that you need to
take a medication the morning of surgery. (Please inform our office if you are
advised to take a medication at this time.)

_______ You will need someone to drive you home from the hospital after surgery.
_______ You will be provided with specific discharge instructions at the hospital.
PLEASE :
______Notify our office if you become ill with cold-like or flu symptoms
AS SOON AS POSSIBLE.
PRE-OPERATIVE SURGICAL INSTRUCTIONS
OUR OFFICE is responsible for obtaining the surgical pre-certification and verification from
your insurance company. **This will be done A FEW DAYS prior to your admission date.**
Hospital information: Our office will provide you with a map and directions.
_____ The Hospital (NOT OUR OFFICE) will call you one or two days before your
_____ They will let you know where and what time to report the morning of your surgery. (This is usually two hours in advance of your scheduled
surgery time.)
_____ Please have your list of medications available so they can instruct you
on which medications you should or should not take the morning of
your surgery.
_____ WHAT TO TAKE TO THE HOSPITAL
You may bring personal toiletries; easy to put on clothing (elasticized
waist and loose front buttoned clothing are suggested) for your
discharge day; your insurance card or claim information; personal items.
_____ YOU SHOULD NOT: wear any jewelry (including wedding bands); no
make-up, nail polish (including toenail polish) to the hospital (If you are
wearing artificial nails, you only need to remove one nail from any index
finger). It is recommended that you not bring any valuables, and only a
minimal amount of cash.
POSTOPERATIVE RESTRICTIONS
For 1-3 weeks after surgery:

_____ LUMBAR SURGERY
• No Sitting for longer than 30 minutes at one time • No lifting more than 5-10 pounds • No bending or twisting • No driving
_____ CERVICAL SURGERY
• No lifting more than 5-10 pounds • No driving INCISION CARE
______Make sure your incision is evaluated on a daily basis. Please report any redness, swelling, moderate to large amounts of drainage, yellow or green drainage, fever more than 100.5 or chills. _____Your sutures or staples must be left in for 7 to 14 days following surgery. They will be removed at your post operative appointment. If you are unable to make your first post-op appointment, please contact the office and speak to a _____You may shower, but must keep the incision dry until the sutures or staples are removed. You may use some type of plastic wrap to keep water off the incision. POST-OPERATIVE APPOINTMENT

_____A post–op appointment will be made for you to follow up in our office. If you would
like to know the date of your appointment prior to your surgery, you may call the
office and ask to be directed to the appointment desk. Your post-op appointment date should
also be provided at the time of your discharge from the hospital.
Patient Signature_____________________________________Date_________________
Nurse’s Initials_______
If you have any questions, please feel free to contact our office at 1-877-635-5234 or
412-630-7640 and someone can assist you.

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