Pre-Operative Appointment

Preparing for surgery can feel overwhelming. We have put together helpful information to make the process easier, ensure you know what to expect, and help set you up for a smooth recovery. If you have any questions or concerns along the way, please do not hesitate to reach out to our team. We are here to guide and support you through every step of the process.

Pre-Operative Appointment

You will need a preoperative medical evaluation with your primary care provider within 30 days of surgery. Depending on your medical history, you may also need an evaluation at the hospital where your procedure is scheduled. Please arrange this appointment early in the 30 day window, as additional testing or medical clearance may be required and could affect your surgery date.

If you are under the care of a specialist, such as a cardiologist, nephrologist, rheumatologist, or pulmonologist, you may need separate clearance from that provider. Our surgical coordinator will give you specific instructions based on your medical history. Please contact our office with any questions about the clearance process.

Your evaluation may include blood work, an EKG, or a chest X-ray. If required, our team will explain where and when these tests should be completed. If you have not seen your primary care provider recently or have multiple medical conditions, we recommend scheduling an appointment before your formal preoperative testing.

Medications to Stop Prior to Surgery

Make sure to discuss with Dr. Fliegel

1. Aspirin - This includes enteric coated aspirin, baby aspirin, regular aspirin, and other products containing aspirin. Depending on your medical history, you may be instructed to stop aspirin 1 week before surgery or continue taking low dose aspirin. Please follow the instructions provided by your surgical team and prescribing physician.

2. Coumadin (warfarin) - Speak with the prescribing physician about whether and when this medication should be stopped before surgery. Do not stop taking it without medical guidance.

3. Celebrex (celecoxib) - Stop taking Celebrex 1 week before surgery unless instructed otherwise.

4. Ibuprofen (Advil or Motrin) - Stop taking ibuprofen 1 week before surgery.

5. Naproxen (Aleve or Naprosyn) - Stop taking naproxen 1 week before surgery.

6. Plavix (clopidogrel) - Speak with the prescribing physician about whether and when this medication should be stopped before surgery. Do not stop taking it without medical guidance.

7. Herbal products and supplements - Certain herbs and supplements may increase your risk of bleeding or interfere with anesthesia. Examples include chondroitin, danshen, feverfew, garlic supplements, ginger supplements, ginkgo, ginseng, quilinggao, and fish oil. Please provide your surgical team with a complete list of everything you take and follow their instructions about when to stop.

8. GLP 1 medications - These medications are commonly prescribed for type 2 diabetes and weight management. They may slow stomach emptying and require special instructions before anesthesia. Examples include:

Semaglutide (Ozempic or Wegovy)
Exenatide (Byetta or Bydureon)
Liraglutide (Saxenda or Victoza)
Dulaglutide (Trulicity)
Lixisenatide (Adlyxin)
Tirzepatide (Mounjaro or Zepbound)

Do not stop these medications on your own. Your surgical and anesthesia teams will tell you whether they should be held and for how long before surgery.

Preparing Your Home For After Surgery

Below are a few helpful tips to make your recovery at home easier and safer after surgery:

Move frequently used items, especially in the kitchen, bathroom, and bedroom, to shelves or drawers that are easy to reach.
Keep all medications within easy reach.
Keep a cell phone or cordless phone nearby.
Place a list of important and emergency phone numbers in an easily visible location.
Consider using shampoo and soap containers with pump tops, which may be easier to manage than flip top bottles.
Stock your freezer with meals that are easy to reheat and keep precut, nonperishable foods on hand. Using a knife may be difficult immediately after surgery.
Have plenty of water, nutritious meals, and healthy snacks available.
If possible, arrange for assistance with laundry, cleaning, meal preparation, and other household tasks.
Clear pathways between commonly used areas, including the bedroom, bathroom, kitchen, and living room.
Remove loose rugs and clutter, and keep stairs and walkways free of objects.
Install nightlights along the route between your bedroom and bathroom.
Arrange to keep pets in another area of the home when you first return, as they may unintentionally create a tripping hazard.

Diet

Healthy eating before surgery prepares your body for recovery and supports healing afterward. Your body needs adequate calories, protein, vitamins, and minerals to repair tissue, maintain strength, and reduce the risk of complications.

The following guidelines can help you choose nutrient rich foods throughout your recovery. Eat a variety of foods to ensure you receive the nutrients your body needs. If you have been prescribed a special diet, continue following it unless your healthcare provider instructs you otherwise.

Protein
Protein supports wound healing, tissue repair, and muscle strength. Include protein with every meal.

Food examples: Chicken, turkey, fish, lean meat, eggs, Greek yogurt, cottage cheese, milk, beans, lentils, tofu, nuts, seeds, and protein shakes.

Iron

Iron helps your blood carry oxygen throughout your body. Low iron levels may contribute to fatigue and slower recovery.

Food examples: Lean red meat, poultry, seafood, beans, lentils, fortified cereals, spinach, and leafy green vegetables.

If you take Coumadin or another blood thinner, speak with your physician before making significant dietary changes.

Vitamin C

Vitamin C supports wound healing and helps your body absorb iron.

Food examples: Oranges, strawberries, kiwi, cantaloupe, tomatoes, bell peppers, broccoli, and potatoes.

Calcium and Vitamin D

Calcium and vitamin D support bone health and healing.

Calcium sources: Milk, yogurt, cheese, fortified plant-based milk, leafy green vegetables, almonds, and canned salmon.

Vitamin D sources: Salmon, tuna, egg yolks, milk, and fortified foods.

Ask your physician before beginning a vitamin D or calcium supplement.

Fiber and Fluids

Anesthesia, pain medication, and reduced activity can cause constipation. Drink plenty of water and include fiber in your diet.

Fiber sources: Fruits, vegetables, beans, oatmeal, whole grains, and prunes.

Foods to Limit
Limit highly processed foods, fried foods, sugary drinks, and excessive alcohol. Avoid tobacco and nicotine products because they can interfere with healing.

The Day Before Surgery

Eat your usual balanced meals unless instructed otherwise. Avoid unusually large, heavy, or high fat meals. Follow the eating and drinking instructions provided by the hospital and anesthesia team. Failure to follow these instructions may delay or cancel your surgery.

After Surgery

Begin with smaller, lighter meals if you experience nausea. As your appetite returns, continue eating protein rich foods, fruits, vegetables, and whole grains. Contact your surgical team if you cannot eat or drink, have persistent vomiting, or develop severe constipation.

The Day Before Surgery

In the days leading up to surgery, eat a healthy, balanced diet and drink plenty of fluids to remain well hydrated.

Research has shown that taking Tylenol 1,000 mg every 8 hours on the day before surgery may improve pain control and reduce the need for opioid medication afterward. Unless you have been instructed not to take Tylenol, we recommend following this schedule. Do not take Tylenol if you have an allergy to acetaminophen, significant liver disease, or another medical reason to avoid it. Be sure to include all medications containing acetaminophen when calculating your total daily dose.

The Night Before Surgery

Follow the eating and drinking instructions provided by the hospital and anesthesia team. Unless you are told otherwise, do NOT eat or drink anything after midnight, including water, coffee, gum, mints, or candy. Follow the hospital’s instructions exactly, as eating or drinking outside the approved times may delay or cancel your procedure.

1. Contact our office as soon as possible if you develop a fever, cold or flu symptoms, vomiting, diarrhea, a skin rash, an open wound, or any other sign of infection.

2. Try to get a good night’s sleep so you are well rested for surgery.

3. Bathe or shower the night before or the morning of surgery. If you were given a special cleansing solution during your preoperative evaluation, use it as directed.

4. Remove all nail polish before arriving for surgery. Your fingers may be used to monitor your oxygen level during the procedure.

5. Do not apply creams, lotions, makeup, or fragrances on the day of surgery. A small amount of deodorant is acceptable unless the hospital instructs you otherwise.

Surgeries at Main Line Health Paoli Hospital

You will typically be asked to arrive about 3 hours before your scheduled procedure. The hospital will contact you the day before surgery, usually between 12:00 and 5:00 PM, to confirm your arrival time and registration location. Please make every effort to arrive on time.

Most patients return home on the day of surgery, although some may stay overnight depending on the procedure, medical history, and recovery after anesthesia. Our priority is to make sure you are safe and comfortable before discharge. Please discuss any concerns or preferences with your surgical team before surgery.

Whenever possible, patients are discharged directly home, however, if additional assistance may be needed, your care team will help determine the safest discharge plan.

If you are staying overnight after surgery, please review the list below for recommended items to bring with you.

A comfortable change of clothes. Choose loose fitting clothing that will accommodate postoperative swelling, dressings, braces, or slings.
Comfortable shoes with nonslip soles.
Personal items such as glasses, hearing aids, dentures, contact lenses, and any necessary storage containers or cleaning supplies.
Your CPAP or BiPAP machine if you routinely use one. Patients who require CPAP or BiPAP may need to stay overnight for monitoring.
A photo ID and your current insurance cards for registration.
Your cell phone and charger.

Surgeries at Paoli Surgery Center

You will be contacted the day before surgery, typically between 12:00 and 5:00 PM, to confirm your scheduled arrival and procedure times. All patients will go home the same day as their surgery. Please arrive on time, as surgeries may begin earlier in the day compared to at Paoli Hospital.

Questions About Your Surgery?

Contact our office for more information