Preparing for Surgery

Arrange for your caregiver to take you home from the hospital or rehab facility on the day of your planned discharge. They should be prepared to pick you in the morning.
Your discharge medications can be prescribed to your home pharmacy or can alternatively be picked up at the hospital pharmacy, make sure to clarify with your team your preference.
Arrange for a family member or friend to stay with you for at least 2-3 days after discharge. They should be able to help with shopping and housekeeping during your recovery.
If you have pets, ensure a family member or friend can help to feed them and/or walk them. Pets, while loveable, can be a tripping hazard, so take precautions.
Consider arranging your living circumstance such that you do not have to climb up and go down many stairs. This is often a barrier to getting home after surgery as we need to ensure you can safely navigate your home.
Further, consider a living circumstance where items you use regularly in the kitchen, bathroom, and bedroom are all within reach.
Minimize all tripping hazards in the house including throw rugs, electrical cords, etc.

No Smoking

Smoking significantly increases the risk of surgical complications and mortality after surgery. Should be stopped a minimum of 4 weeks prior to surgery. (See Lau et al.)

Reduce Alcohol Consumption

Drinking >2 units of alcohol increases postoperative complications. Consumption should be limited 4 to 8 weeks prior to surgery. (See Eghol et al.)

Weight Loss

Obesity is associated with increased risk of post-surgical complications following lumbar spine surgery (prominent for BMI >40). (See Marquez-Lara et al.)

Improve Blood Sugar Control

In diabetics with poorly controlled blood sugars (HgbA1c>7.5), there was a significant difference in likelihood of a good outcome after lumbar spine surgery (See Gupta et al.)

Walking for general fitness

In a landmark JAMA study, increased daily step counts were associated with significant decreases in mortality rates, with the benefit increasing as step count increased (See Saint-Maurice at el.)

Improve Nutrition

Low blood protein levels (hypoalbuminemia, low transferrin, and low white blood cell counts) have been associated with increased risk of surgical site infections, postoperative complications, increased length of hospital stay, 30-day readmission rates, and mortality following spinal surgery. (See Debono et al.)

Please refer to your specific instructions from your pre-operative appointment for what you are to stop taking and what to continue taking prior to surgery.
Examples of medications that may need to be stopped prior to surgery (***This list is not all inclusive.***):
- SGLT2 inhibitors
  - Canglifozin (Invokana), Dapagliflozin (Farxiga), Empaglifozin (Jardiance), Ertuglifloxin (Steglatro), etc.
- Oral hypoglycemic agents
  - Metformin, Glucophage Acts, Glyburide, Tolinase, Avandia, Amaryl, etc.
- Insulin
  - Lantus, Levemir, Humulin, Novalog, Humalog, etc.
- Diuretics
  - Lasix, HCTZ, etc.
- ACEi/ARB
  - Lisinopril, Lotrel, Captopril, Lotensin, Monopril, Prinzide, Atacand, Benicar, Diovan, Avalide, Losartan, etc.
- Blood thinners
  - Plavix, Brilinta, Warfarin (Coumadin), Pradaxa, Xarelto, Eliquis, Effient, Aggrenox, Pletal, Lovenox, etc.
  - Aspirin, NSAIDs
- Bisphosphonates
  - Alendronate (Fosamax), Risedronate (Actonel), etc.
- PDE-5 Inhibitors
  - Sildenafil (Viagra), Tadalafil (Cialis)
- Bladder Dysfunction medications
  - Mirabegron, Oxybutynin, etc.
- Muscle Relaxants
  - Flexeril, Soma, Skelaxin, Robaxin, etc.
- Migraine medications
  - Sumatriptan, Rizatriptan
- Herbal and alternative supplements

At your clinic visit, your surgeon will review your medical history, coordinate your medical clearances, and provide further information about your specific procedure and recovery process.
Prior to surgery - it is likely that you will need to see:
- Your Primary Care Provider (PCP) for a general surgical clearance.
- If you have significant cardiac/pulmonary or other co-morbidities, you may also need to see your specialist for further clearance to ensure surgery is as safe as possible.
- Additional imaging and labs- further CT/MRI/x-rays as well as labs may be necessary to ensure surgery is as safe as possible.
- The Pre-admission Clinic at the hospital where you will have your procedure.
- If there are any changes in your medical condition or new medications prescribed, please reach out to the clinic to update.

Apex Brain & Spine Neurosurgical Specialists

Preparing for Surgery

Apex Brain & Spine
Neurosurgical Specialists