Preparing for surgery

Controlling your blood pressure to safe levels reduces your risk of heart disease or stroke. If you have had high blood pressure before or you are currently taking medicines to manage your blood pressure, your healthcare provider can check your blood pressure. They can help you make sure it is well controlled before your surgery.

High blood pressure (hypertension) (internal link)

Chronic lung disease includes long term breathing conditions like:

• emphysema
• chronic obstructive pulmonary disease
• bronchiectasis.

Chronic obstructive pulmonary disease (COPD) (internal link)

If you have chronic lung disease you might feel short of breath with gentle activity, cough up phlegm or mucus even when you are well and might often be unwell with chest infections. In Aotearoa New Zealand, one of the most common causes of chronic lung disease is smoking.

Having chronic lung disease brings a higher risk of breathing complications during and after surgery. There are several ways you can reduce this risk.

• Reduce or stop smoking.
• Do regular activity to improve the strength of your breathing muscles.
• Learn and practice breathing exercises that you can do after your surgery.
• See your healthcare provider to make sure you are on the right medical treatment, like inhalers.
• See your healthcare provider early if you have any new worries about your breathing, or if you think you are developing a chest infection.

Quitting smoking | Te whakamutu i te momi paipa (internal link)

Things to watch out for that are signs of chest infection include:

• having a fever or high temperature
• feeling more short of breath than normal
• making more phlegm or mucus, or the colour of it changes from clear to brown or green.

It is important to get checked out early and be on the right treatment plan to be as well as possible before your procedure.
    

Obstructive sleep apnoea (OSA) is a condition that can cause you to stop breathing for short periods of time while you are asleep.

If you have OSA, you might:

• be a loud snorer
• struggle to breathe while asleep or even pause your breathing then appear to wake suddenly (other people you live with may see this) — it can happen many times through the night.

If you have OSA, you might not remember these night-time episodes but you may notice other effects instead. These include:

• feeling tired or sleepy through the day
• having headaches
• have trouble thinking clearly.

If OSA is not treated, it can lead to other problems like high blood pressure and heart disease.

There are ways to treat or manage OSA. If you think you might have OSA, see your healthcare provider.

If you have untreated OSA you more likely to have complications after surgery. Getting diagnosed and started on treatment helps reduce your chance of complications.

If you have already been diagnosed with OSA and you use a mask to help your breathing at night, bring this with you to hospital when you have surgery so it can be used during your hospital stay.

As part of your assessment for surgery, you will be asked to have a blood test. If this shows you have anaemia (a low red blood cell count) or low iron levels, you will be referred to the hospital blood management service.

The hospital will contact you to organise treatment to boost your iron levels with oral iron or an iron infusion either at the hospital or at your healthcare provider. Treatment helps to get your iron levels closer to normal before your surgery or procedure. 

Treating your anaemia before surgery:

• reduces the need for you to have a blood transfusion during surgery
• reduces the risk of complications
• helps you recover faster
• leaves you feeling less tired after surgery
• shortens your stay in hospital.

Why iron is important 

Iron deficiency anaemia is the most common type of anaemia. It happens when your body's level of iron mineral is too low. You use iron to:

• make haemoglobin, which helps the blood carry oxygen around your body
• keep your immune system healthy, to fight infections
• maintain your energy.

If you have anaemia your symptoms can include:

• feeling tired
• being irritable
• feeling cold
• being unable to concentrate
• getting frequent infections.

Questions you may ask 

Your healthcare team can explain transfusion risks, benefits and any alternatives that are available to you.
Before your surgical or medical treatments, you may wish to ask some questions.

For your healthcare provider or nurse

• Am I anaemic or is my iron level low?
• If so, how can my iron level be improved before my treatment?
• Are there any medicines or herbal or vitamin supplements I should stop or start taking before my treatment?
• Is there anything I can change in my diet so I can be healthier to support my recovery?

For your surgeon or anaesthetist

• Will I need a blood transfusion with my planned surgery or treatment?
• What are the risks with a blood transfusion?
• What options are there for me to avoid a transfusion?
• What if I do not want to receive a blood transfusion?

How patient blood management works

Patient blood management focuses on 3 areas.

Optimise your blood before surgery or treatment — identifying and treating anaemia before your planned surgery or medical treatment. .

Reduce blood loss — minimising  blood tests and samples before surgery and using modern techniques to help reduce bleeding during your planned surgery.

Manage anaemia — your body can adapt to lower levels of haemoglobin (the molecule that carries oxygen inside red blood cells) caused by blood lost during surgery. A blood transfusion is not always needed. You can be given iron tablets or intravenous iron instead, to help increase your haemoglobin levels.

If you need a blood transfusion

If you need a blood transfusion, patient blood management means the transfusion is safe and you are only given what you need.

Your doctor can explain the transfusion risks, benefits and any alternatives available to you. Ask if you have any questions or concerns. There are clear processes for people who, for religious or other reasons, refuse blood transfusions. Let your healthcare providers know as soon as possible, so they can discuss options with you.

In the weeks leading up to your operation, try to choose foods that help make your body strong. These foods include:

• protein (for example, meat, dairy products, beans, peas and pulses, and eggs)
• calcium (for example, in dairy products, soy beans, dark green leafy vegetables)
• fruits and vegetables
• iron (for example, in meat, seafood, beans, dark green leafy vegetables).

For some operations your surgeon might recommend losing weight before surgery, if you have a certain body type. This might be because:

• the operation has much higher risk if you have a bigger body
• it is hard for the surgeon to do the operation.

Losing some weight can make things much easier. Your surgical team will explain this during your appointment.

Most of the time, it is more important before surgery to focus on keeping your body moving and eating foods that will help your body heal and recover — rather than trying to lose weight.

Having an operation can be a very big deal. You may feel worried or anxious while you are waiting for surgery, or when you get to hospital. It is important to recognise if you feel this way and, ideally, to work with whānau to find ways to help you relax and keep positive. Some people like to use mindfulness exercises or breathing techniques — your healthcare provider may also be able to offer you useful resources.

You can have a support person stay with you before your surgery. There is cultural and spiritual support through the kaitiaki and chaplain service before and after surgery, if you request it.

If you smoke you are more likely to have complications during and after surgery. These smoking-related complications are things like:

• heart attacks
• blood clots
• chest infections
• infections in the surgery wound.

These can mean needing another operation and taking longer to recover and get discharged from hospital.

We strongly recommend you stop smoking before having an operation. The best results happen when you stop at least 6 weeks before surgery. Even stopping just a few days before will still make a difference.

You are more likely to successfully stop smoking if you have support, especially from trained ‘Stop Smoking’ advisors. You and your whānau may have a support network, and you can get help to connect with the services designed to help you quit.

Quitting smoking | Te whakamutu i te momi paipa (internal link)

You can also call Quitline on freephone 0800 778 778.

Quitline | Me mutu (external link)

Vapes

Electronic cigarettes or ‘vapes’ have been used to help people quit smoking. The ingredients in vapes are not as harmful as cigarettes but they can still cause complications when they are used before surgery.

The listed ingredients in vapes are unreliable. Even ‘nicotine free’ vape liquids can contain nicotine, and nicotine-containing vape liquids can have much more nicotine than in regular cigarettes.

To have the best results from your surgery, stop vaping in the same way you would stop cigarette smoking — for as long as you can beforehand, and ideally at least 6 weeks before surgery.

Vaping (internal link)

Alcohol has many effects on your body, including causing harm to your heart and liver. This can affect how your body processes medicines given during your hospital stay. It can also increase bleeding during surgery.

Make sure you are drinking less than the recommended limits to improve your body’s ability to heal after surgery. It is recommended to drink less than:

• 2 standard drinks daily for women (10 standard drinks per week)
• 3 standard drinks daily for men (15 standard drinks per week).