People sometimes think that the stress of surgery is simply a matter of going to and from the hospital. However, particularly after the age of 60, the risks may already have begun: a missed dose of medication, an incorrectly observed fasting period, or a hidden habit can directly affect your recovery after surgery. In this article, we will discuss seven important precautions you should take before going into surgery, in a straightforward and honest manner. Preparation is not just about the date and packing your bags; it is about safeguarding your health.
1. Please list all the medicines, vitamins and supplements you are taking
You must inform your doctor of every single medication you are taking prior to surgery – whether it is prescription, over-the-counter, a vitamin or a herbal supplement. Patients usually mention their blood pressure or cholesterol medication, but often forget to mention aspirin, painkillers, sleeping pills or herbal supplements. However, your body treats these substances in the same way as prescription medication; the risk of bleeding may increase, blood pressure and heart rate may change, and the anaesthesia plan may be affected.
Therefore, please write down the name, dose, and timing of every medication you are taking on a single-page list. Do not stop taking your high blood pressure or diabetes medication without receiving specific instructions from your doctor; depending on the situation, some may still be taken on the morning of the operation.
2. Please ensure you follow the fasting instructions strictly
If food or liquid remains in your stomach during anaesthesia, there is a risk of it entering your lungs (aspiration); however, going without food for an unnecessarily long period can also cause weakness and low blood pressure in elderly patients. You should therefore obtain clear instructions from your anaesthetist: find out what time you can have your last solid meal and your last drink (water, unsweetened tea, coffee, etc.).
According to the ASA, a healthy patient may drink fluids for up to two hours before surgery. However, your personal instructions may vary depending on conditions such as diabetes, reflux or stomach problems. Ignore any last-minute suggestions such as ‘A small piece of dry biscuit or a cup of coffee won’t do any harm’ and adhere strictly to the correct fasting period.
3. Do not hide your smoking, nicotine, alcohol and similar habits
Do not under any circumstances conceal your use of tobacco, nicotine or alcohol prior to surgery. Research shows that post-operative heart and lung complications, infections and wound healing problems are much more common in smokers. Whilst nicotine constricts blood vessels and makes it difficult for oxygen to reach the organs, carbon monoxide disrupts the transport of nutrients in the body; this makes both the anaesthesia during surgery and the recovery process more difficult.
Alcohol dependence or heavy use can also cause post-operative withdrawal symptoms, fluctuations in blood pressure and confusion. Don’t be embarrassed to tell your doctor, “Yes, I drink/use regularly.”
4. Start Strong and Balanced; Plan Your Blood Sugar
As we age, muscle strength and reserves decline. Muscle loss accelerates after the age of 60, and even short hospital stays can lead to significant weakness in people over 70. As surgery places a great deal of stress on the body, sufficient fuel is required for recovery. Accordingly, you should increase your protein intake a few weeks beforehand, take iron supplements if you are anaemic, and drink plenty of water.
Instead of going into surgery on an empty stomach, make sure you are mentally and physically prepared. If you have diabetes, discuss with your doctor how to check your blood sugar levels at night and on the morning of the operation, and what you should do at different levels. Do not stop taking your diabetes medication thinking, “I’m having an operation anyway, so I won’t take it”; your doctor will tell you your target blood sugar levels and protect you from unnecessary risks.
5. Describe any existing health issues and your habits
Your doctor will want to know all the details so that they can provide you with the best possible care. If you have sleep apnoea, severe snoring or pauses in breathing during the night, or if you use a CPAP machine, please be sure to mention this – as anaesthesia and painkillers can slow down your breathing, these conditions require extra monitoring. Do not withhold details that may seem ‘minor’, such as regular alcohol consumption, frequent episodes of dizziness, chronic cough, or a history of frequent urinary tract infections.
For example, in patients who become disoriented or aggressive after surgery, the underlying cause is often pain, infection, dehydration or a drug interaction. So don’t hesitate to ask your doctor, “What is causing this symptom?” Remember, do not expect your doctor to guess any hidden health information; the more you share, the safer the treatment plan will be.
6. Do not neglect the surgical site and skin problems
Shaving the area near the surgical site with a razor increases the risk of infection. Numerous studies show that shaving hair with sharp instruments creates microscopic cuts on the skin’s surface, thereby increasing the likelihood of infection.
Surgeons usually prefer to remove hair using suitable razors when necessary; all you need to do is make sure there are no cuts or injuries on your skin.
Please also be sure to report any signs of infection, such as redness, a rash, an abscess, discharge or a high temperature. These symptoms may lead to the surgery being postponed, but the most important thing is to prevent an infection from developing later on. Healthy skin is essential for a speedy recovery after surgery.
7. Make a plan for the first few days after the operation
Although most patients make plans for the day of their operation, they often forget about the aftermath; yet the first 72 hours are critical. Problems such as falls at home, dehydration, medication mix-ups and disorientation are common after surgery. For example, if the lighting in the post-operative ward is dim and you do not have your glasses or hearing aid with you, your sense of orientation may be disrupted within a short time. Be prepared for this situation: decide who will arrange your return home on the day of the operation and who will look after you during the first two days at home.
Remove any loose rugs that could cause a trip at home, and keep frequently used items (water, medication, glasses, phone) within easy reach. Find out when you should get up, have a bath or resume taking your medication immediately after the operation.
Remember, recovery is often compromised in older people when conditions known as the “geriatric syndrome” (such as dehydration, delirium and falls) are common. Even in the absence of high blood pressure, brain or kidney problems, dehydration is a condition observed in 66% of patients. For this reason, do not leave hospital without ensuring you have plenty of water, easily digestible food and a restful environment at home following surgery.
In conclusion, if the details of pre-operative preparation are taken lightly, the recovery process becomes more difficult. Making a list of all your medications and discussing them with your doctor, following the fasting guidelines correctly, clearly explaining your habits, and planning your recovery at home will help protect you from potential risks.
At your next doctor’s appointment, don’t hesitate to say: “I’m over 60 and I want to prepare for my operation as safely as possible.” When you’re having a conversation, don’t be afraid to ask any questions you have – you deserve this for the sake of your health. Remember, the best outcome of surgery is usually determined by the steps taken before you even enter the hospital.
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