Planning and preparation

Friday 1 April, 2016

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  On this page: Preoperative assessment | Understanding the risks | Informed consent | Preparing for surgery | Key points | Frank's story


To make the process of planning and having surgery easier, you need to:

  • have the required preoperative tests
  • understand the risks and possible complications, and give your informed consent
  • follow specific instructions about how to prepare for surgery.

Preoperative assessment

During a preoperative assessment appointment, your medical team will check your fitness for surgery. The health professionals you see will vary depending on the type of cancer and surgery and your general health, but they could include:

  • the surgeon or another member of the surgical team, such as a resident medical officer or registrar
  • the anaesthetist or another member of the anaesthesia team, such as a specialist nurse or registrar
  • a physiotherapist to show you exercises to do before surgery
  • to improve the chances of a smooth recovery.

You will be asked about your medical history and any medicines you are taking. You may also have tests such as blood tests, urine tests and a chest x-ray, and imaging tests such as CT, MRI or PET scans. You probably won’t need to have all of these tests and scans.

Tell the doctor if you are taking any over-the-counter or herbal medicines, as these could affect the surgery and your recovery.

You will be told whether you will have surgery as an inpatient or outpatient, what to take to hospital, and other useful information (see preparing for surgery). Your legs may be measured for stockings to help reduce the chance of developing a blood clot in your veins (deep vein thrombosis or DVT). You might wear these during surgery and for a short time afterwards.

If you will need support services after surgery, such as the advice of a dietitian or social worker, you will be given referrals for these.

If you are having minor surgery, you may not need to attend a preoperative assessment appointment. Your doctor will discuss

the surgery and how to prepare at one of your usual appointments.

Understanding the risks

Almost all medical procedures have risks, and surgery is no exception. Factors to consider when weighing up the risks and benefits include:

  • the length of the operation
  • the type of anaesthetic you will have
  • your age and general health.

Although advances in surgical techniques have made surgery safer, there are still things that may not go as planned. Possible complications are discussed in the day of the surgery and recovering from surgery. Overall, you and your surgeon should feel that the expected benefits outweigh the possible risks.

Informed consent

A doctor needs your agreement (consent) to perform any medical treatment. Receiving and understanding information about treatment before agreeing is called informed consent.

Adults can give their consent – or refuse it – if they have capacity. Capacity means they can understand the information about the proposed choices and make decisions based on this information.

Sometimes consent is not needed, such as in a medical emergency. However, if your surgery is planned, your doctor will discuss:

  • why you need the surgery and its benefits
  • other treatment options
  • how they will perform the surgery
  • possible side effects, risks and complications.

For more information about consent, read Cancer Care and Your Rights or call Cancer Council 13 11 20.

Waiting for surgery

It’s common to have to wait for surgery. The length of time depends on many factors, including the type of cancer you have and its stage, the surgery you are having and the hospital’s schedule. In most cases, waiting doesn’t have a major impact on the surgery outcome. If you are anxious or concerned about waiting for surgery, speak to your surgeon or call Cancer Council 13 11 20.

Preparing for surgery

At the preoperative assessment appointment, you will be given instructions about how to prepare for the surgery based on your health and medical history. Let your treatment team know if you have any concerns about what you are asked to do. The advice you receive will cover the following issues:

Bathing and shaving

You will be told to shower or bathe either the night or morning before surgery. If you have been told that hair near the surgical site will need to be shaved, you may be asked to do it yourself before you go to hospital, or it will be done when you are admitted. In cases where there is a lot of hair at the surgical site, you will be asked to avoid shaving the area yourself, as any cuts to the area can increase the risk of infection.

Eating and drinking

Most people are told not to eat or drink for 6–12 hours before surgery. This may be called fasting or nil by mouth, and it ensures that your stomach is empty before surgery. This reduces the risk of some complications. In some cases, you can continue drinking clear fluids until two hours before surgery – your surgeon or anaesthetist will advise you on this. You should also avoid drinking alcohol and smoking for at least 24 hours before the operation.

Smoking can delay your healing and recovery time. If you smoke, try to quit before you have surgery. Giving up smoking can be difficult. For help, talk to your doctor or call the Quitline on 13 7848.

Medicine

Your doctor will tell you whether to keep taking any medicine you are on or to stop taking it in the days or weeks before surgery. If you’re instructed to fast and have to take medicine, swallow it with a small mouthful of water.

Support person

You may want to ask a friend or family member to stay in the waiting room while you are in surgery.

If you are having day surgery, you should arrange for someone to take you home when you are discharged. It’s not safe to travel alone or use public transport or a taxi, as you will still be under the effects of the anaesthetic. If your treatment centre has a social worker, they can help organise transport if necessary.

Personal items

Your treatment team will let you know what personal items to take to hospital with you and what to leave at home. For example, they may tell you to take all your current medicines with you, but suggest you leave valuables, such as jewellery, at home.

You will be asked to remove nail polish, including clear polish, before surgery. Checking your fingernails during surgery is one way the anaesthetist can monitor the level of oxygen in your blood.

Key points

  • Your medical team will determine if you are fit enough for surgery by looking at your medical history and doing tests and scans. This is known as a preoperative assessment.
  • You will be asked whether you are taking any medicines. Tell the doctor if you are taking over-the-counter or herbal medicines, as these could affect the surgery and your recovery.
  • The doctor will explain whether you will have surgery as an inpatient or outpatient. You may be measured for stockings to help prevent blood clots.
  • If you will need support services after surgery, such as a dietitian, you will receive referrals for these.
  • There are risks associated with any surgery. Your doctor will explain these.
  • The doctor needs your agreement (consent) to perform the operation. Receiving relevant information about the benefits and risks of surgery before agreeing to it is called informed consent.
  • It’s common to have to wait for surgery. Your waiting time depends on how urgent your case is and the schedule of the hospital where you will have the surgery.
  • To prepare for surgery, you will be given instructions based on your health and medical history. Instructions will cover issues such as bathing and shaving, eating and drinking, medicines you are taking, transport home from the hospital, and what to take with you.

Frank’s story

When my mum was diagnosed with bowel cancer, the medical team recommended she have a right hemicolectomy to remove the affected parts of her bowel.

Before surgery, we went to the hospital to see the surgeon for the pre-assessment appointment. My wife and I went along to provide support and help Mum understand the surgeon’s instructions.

The surgeon talked to the three of us about the potential risks and benefits of the hemicolectomy. Mum’s elderly and she had heart problems a few years ago, so she takes low-dose aspirin daily. The doctor explained the risks of bleeding during the operation and told Mum to stop taking aspirin for a week before the surgery.

Even though it was stressful to ‘download’ all the medical information and instructions, the pre-assessment actually eased our minds. I walked away knowing that although it’s a major operation, very few people die. I also knew the practical things we had to do to help Mum prepare.

On the day of the surgery, we all felt nervous but ready. Mum was in theatre for a while, but she got through the operation without any problems. Over time and with the dietitian’s help, she resumed eating.

When I look back, I think Mum was calmer than us. It can be really nerve-racking and stressful to be the support person for someone having surgery. We found it helpful to ask the medical team questions about what was happening so we felt in control and knew how to look after her.


Reviewed by: A/Prof Gavin Wright, Director, Surgical Oncology, St Vincent’s Hospital, VIC; Mr Chip Farmer, Colorectal Surgeon, The Alfred Hospital, Cabrini Hospital and The Avenue Hospital, VIC; Carmen Heathcote, Cancer Support Advisor, 13 11 20, Cancer Council Queensland, QLD; Anna Hrynko, Consumer; Georgie Palmer, Physiotherapist, Physiofit, TAS; Karen Redman, Breast Care Nurse Practitioner, Breast/Endocrine Surgical Oncology, The Queen Elizabeth Hospital, SA; Dr Shomik Sengupta, Urologist, Sengupta Urology, VIC; Dr Anica Vasic, Head, Pain Management Unit, St George Hospital, NSW.
Updated: 01 Apr, 2016