Paragon Press – June 2015

Can My Medications Hurt Me During Surgery?

If you have had surgery, you more than likely were told not to eat or drink after midnight the night before surgery, except for one or two medications taken with a small sip of water in the morning. The surgeon needs to know exactly what you are taking to know what pills are vital to your health and those that cannot be skipped. Wait…there are more reasons to be very thorough when making that list. Read about these commonly used medications to understand more fully how they impact your body during surgery.When you go in for a healthcare-related appointment, you usually fill out paperwork listing all your medications. You might not be very careful to list every single last one, but did you know it is crucial to list every prescribed and unprescribed medicine when you go in for orthopedic surgery? Your surgeon needs to know each drug you take, its dosage, and what it does for you in order for your surgery to have the best outcome possible. Your primary care physician should be able to give you a complete list of prescription medications to take to your surgeon, and don’t forget about anything bought over the counter that you take.

DID YOU KNOW? Nearly 70% of Americans are prescribed at least one medication.

Blood Pressure Medications: These are usually continued the day of surgery to maintain your regulated blood pressure. If your medication and blood pressure have not been stabilized prior to surgery, it could mean a delay for your procedure. A stable blood pressure is a must before undergoing any surgical procedure.

Diabetic Medications: Because the stress of surgery can lead to higher blood glucose levels, your insulin might need to be adjusted for surgery. Some oral diabetic medications may need to be stopped before you are given anesthesia.

Blood Thinners: In most case, these need to be stopped 5-7 days prior to surgery. Your surgeon will let you know how soon to stop taking them and when to resume them. The reason for this is thinners cause extra bleeding that could cause swelling or an infection at your surgical site.

Steroid Medications: To maintain your body’s steroid levels, which are important for blood pressure regulation, these are usually continued the day of surgery. If your steroid level drops, it could lead to low blood pressure problems during surgery. This is dependent on what levels of steroids you take, so be specific about your dosage with your surgeon.

Heart Medications: These are normally continued the morning of surgery, taken as usual. A thorough heart history is necessary before surgery. Sometimes, additional heart medicines, called beta blockers, are added to decrease the risk of any heart problems during surgery.

Dietary Supplements: Some over-the-counter supplements can interfere with medications necessary for your surgery. Other over the counter substances can cause surgical bleeding. Taking them can lead to complications, so be thorough about reporting them all.

Immunosuppressant Medications: If you are a transplant patient, or have an inflammatory condition, such as arthritis, the immunosuppressants you might be taking could significantly slow wound healing after surgery. Have a discussion with your surgeon about temporarily stopping these.

Understanding the impact of medications on your body’s processes gives more insight into your surgeon’s need to know in advance. Always be detailed about anything you are taking for the best surgical outcome.

The following articles were referenced in making this newsletter:

Preparing for surgery, medication checklist; why the surgeon needs to know about them

Paragon Press – July 2014

What You Can Do To Increase Your Chances of Successful Surgery

First, are you a good candidate?

You have an appointment with your surgeon and he tells you your problem requires surgery. You ask how soon it can be done, and he tells you he can’t do it, or even that he won’t do it. Nobody wants to be told they can’t have what they want, but surgeons realize with some patient choices, the chances of the surgery being successful are slim to none. A surgeon wants your surgery to be successful, just like you do, but did you know certain choices can make you a poor surgical candidate?

Two that are too risky

Statistics show that certain unhealthy behaviors make surgery less successful. Two behaviors which are frequently the cause of poor surgical outcomes are:

  • Smoking
  • Obesity

We would like to think we all heal the same, but studies show this is not the case. Factors such as age and preexisting health problems can be causes for failed surgeries, but they are beyond our control. There is a significant body of research that shows smoking and obesity can drastically decrease the chances of a successful surgical outcome and these are behaviors that a patient can change. Smokers and obese patients in England are being denied for in vitro fertilization, breast reconstruction, and new hip/knee surgery unless they slimmed down or stopped smoking.


A recent study found in the Journal of Bone and Joint Surgery (JBJS) compared the clinical outcomes of nonsmokers, current smokers, and former smokers following knee surgery. The researchers concluded smoking had a negative effect on surgery and heavy smokers showed even worse outcomes. Patients who stopped smoking at least one month prior to surgery had the same outcome as a patient who never smoked. According to the American Association of Orthopedic Surgeons (AAOS), smoking may be the single most important factor in postoperative complications. Smoking complications include:

  • Poor wound healing
  • Infection
  • Less satisfaction in the final outcome of surgery

Broken bones take longer to heal in smokers because of the harmful effects of nicotine on the production of bone-forming cells.

Cigarette smoking is recognized as one of the major causes of preventable disease. Many people are very aware of how smoking affects your lungs, but not many know that it has serious negative effects on bones, muscles, and joints, and that smoking often leads to poorer surgical outcomes, especially in orthopedics.


Two-thirds of the American population is considered overweight or obese. Study after study has shown the deleterious effects of obesity on a person’s health. Obesity is associated with over 60 medical conditions. Among the more studied are:

  • Cardiac fitness-Studies show the stress of surgery on the heart might increase the chances of a cardiac event or increase chance of death in an obese person.
  • Diabetes-In one study of diabetics, 28.3% developed post-operative complications after orthopedic surgery as a result of their diabetes.
  • High blood pressure-This can negatively affect cardiac function, as well as many other organs within the body.
  • Sleep apnea-According to Dr. William Mihalko of the Campbell Clinic at the University of Tennessee, obese patients with sleep apnea have higher complication rates after orthopedic procedures.

Obese patients tend to have poorer outcomes and the expense of treating them is much higher than that for non-obese patients. Complication rates for patients with a BMI over 40 (considered “morbidly obese” is 22%. Children are also included in all these warnings, since nearly one in three children is overweight or obese. Inactivity and obesity combined can take as many as 7 years off life expectancy.

This should open your eyes to what you can do for your health. If you struggle with your weight, it’s easier to take off the weight before arthritis occurs and makes it more difficult exercise. If you can quit smoking even just one month prior to surgery, you have increased chances of surgical success. Talk to your surgeon to make sure you are in the best position to have a successful surgery. Both of you want only the best!

The following articles were referenced for this newsletter: