6 steps to safer surgery

Bad things happen all too often during surgery: Up to 30 percent of patients suffer infections, heart attacks, strokes, or other complications after surgery and sometimes even die as a result, research suggests. Which hospital you go to can make a difference, according to our new surgery Ratings. And a number of steps, described below, can help keep you safe regardless of which hospital you go to.

1. Go prepared

Start healthy. Be as active as possible in the weeks leading up to surgery. Make sure blood pressure and blood sugar are well controlled. If you smoke, quit—even if only temporarily—because smoking slows recovery and increases your risk of infection. See our advice on how to stop smoking.

Schedule carefully. Having surgery early in the week is best. Research shows that the death rate for patients having scheduled surgeries is higher later in the week and on weekends. Staffing may be lighter on weekends, nights, and holidays, and it can take longer to get lab results. Time of day may matter, too: Earlier surgeries may benefit from a fresher surgical team.

Appoint an advocate.  Ask a friend or family member to help monitor your care, by asserting your needs and preferences, asking questions, retaining copies of important medical documents, and advocating for you if problems arise. Ideally, your companion should help you during check-in and discharge, and visit daily.

See our safer-surgery survival guide and our hospital Ratings.

2. Avoid infections

Rid your body of harmful bacteria. Carefully follow your surgeon’s instructions for cleaning your body before you go to the hospital.

Get your nose swabbed. That can check for methicillin-resistant Staphylococcus aureus (MRSA), a hard-to-treat bacteria you might bring into the hospital with you.

Ask about antibiotics. For most in-patient procedures, antibiotics should be started within an hour of your surgery and, in most cases, stopped 24 hours later.

Say no to razors. Razor nicks provide an opening for infection. If hair must be removed, electric clippers are safer.

Stay warm. The drop in body temperature that occurs during surgery can impede blood flow and impair immune function. Ask whether a surgical blanket or another technique will be used to keep you warm.

Insist on clean hands. Ask your nurses, doctors, and anyone who touches you to wash their hands before examining you if you didn’t see them do so.

Ask every day whether tubes can be removed. The longer urinary catheters, central lines, or breathing tubes stay in your body, the greater your risk of developing a potentially deadly infection.

3. Prevent blood clots.

Assess your clot risk. Make sure your doctor asks about factors such as smoking or use of oral contraceptives that can increase the risk of developing a clot, which can cause leg pain or, more dangerously, travel to your lungs.

Ask about prevention. You may need to take blood-thinning medications or to use inflatable cuffs on your legs after surgery to prevent blood clots.

Get moving.  When you’re able, make sure a hospital staff member helps you get out of bed to sit in a chair or walk down the hall.

4. Protect your heart.

Know your risk. If you are 50 or older, your doctor should check your risk of having a heart attack or stroke. To assess your risk, use our heart attack risk calculator.

Ask about beta-blockers. If you are at high risk for heart attack or stroke, ask whether you should be given beta-blockers before surgery to protect the heart from stress hormones that can trigger a too-rapid heartbeat. If you already take beta-blockers, make sure they are not stopped while you’re in the hospital.

5. Keep breathing

Talk about sleep apnea. Tell your doctor and anesthesiologist whether you have sleep apnea, which can increase the risks of anesthesia and pain medications. If you haven’t been diagnosed with sleep apnea but have been told that you snore loudly or you are unusually tired during the day, talk to your doctor about being checked for the condition.

Do deep-breathing and coughing exercises. Make sure someone teaches you those exercises when you are recovering from surgery. They can help prevent pneumonia and partial collapse of the lungs.

6. Get the right drugs.

Bring a drug list. Make sure it includes over-the-counter and prescription medications, vitamins, and herbals, as well as any drug allergies.

Track your meds. The most common drug errors are inadvertent changes to existing medications. Ask your doctor about any changes to your drug regimen during your hospital stay.

Want to know what to do after surgery? See our advice on how to recover from surgery.

—Teresa Carr

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