I am a surgeon. I love to operate. I don’t want to cancel a surgery. By the time you are doing your preop visit with me, you are likely two weeks ahead of surgery. If your surgery is canceled, I likely won’t be able to put someone else into the spot. So why would a surgery get canceled?
- You are sick. (fevers, pneumonia, etc)
- High blood pressure. Many of my patients don’t check their blood pressure regularly, so some do not know they have high blood pressure. High blood pressure can increase bleeding during surgery. If high enough, there are also other risks.
- Abnormal labs. This could be anything: a low blood count, elevated liver function numbers, an abnormality on your mammogram which needs to be worked up, something on your EKG. Surgery is a stress on the body. If you haven’t had regular physicals (Regular doctor visits isn’t seeing your Ob Gyne for your pap smear, but a real visit to an internist with blood work, etc), then I recommend doing it when you first consider having elective surgery. Safety is important. Feeling okay doesn’t guarantee all is okay. I had a patient once who was otherwise healthy who had started an herbal medicine from South America. When she had standard labs done, we found her liver function numbers were out of sorts. We postponed her surgery until her labs were normal again.
- New information which shows increased risk. At your preop I review all of your body systems again. Any heart issues? Any lung issues like asthma, Tb, etc? Any hepatitis or liver issues? Any issues with bleeding? Any issues with blood clots? And so on. I had a patient once who was a closet smoker. At her preop when reading her consent, she realized what a risk smoking was to her surgery (a tummy tuck). Surgery was canceled. I had another patient who had a history of blood clots. Any history of blood clots in you (during pregnancy, plane flights, from birth control pills, etc) or in a close relative is very important. A blood clot in your leg can dislodge and go to your lung. When it does it can be deadly.
- Medications which affect bleeding or anesthesia taken too close to surgery. Exact regimens depend on you and the kind of surgery being done. For most of the surgeries I perform, blood thinning medications (fish oil, NSAIDs, aspirin, vitamin E) and specific other medications (diet pills, ADD medication), must be stopped two weeks ahead of surgery.
As I do mostly elective optional surgeries, we need to make sure we optimize your surgery. Any risks we can avoid, we should avoid. It is rare for me to cancel a surgery. Just as you plan for the day of surgery with rides, someone to take care of you, someone to take care of your kids, and time off work, we have blocked that time for you. When a surgery is canceled close to the date, I cannot fill that time with another surgery.
To avoid any issues, what can you do?
- Get a doctor check up 2-3 months ahead of your surgery date. Have a full work up with labs, and other tests as needed such as mammogram (if over the age of 35 and having breast surgery), EKG (if over the age of 50), or stress test (if you are older with risk factors such as smoking history, high cholesterol, diabetes, high blood pressure, etc).
- By doing your initial physical check up with your doctor a few months ahead, you have time to fix anything which could be an issue (If anemic, you can take iron. If your blood pressure is high, you can start on a medication to fix it.)
- Tell your doctor all your herbal and other medications.
- Tell your doctor if any history of MRSA or drug resistant bacterial infections.
- Be honest if you are smoking. This includes smoking things other than cigarettes.
- If you have a history of blood clots or bleeding, these are important. It requires further work up before doing elective surgery.
Your safety is paramount.