Patients waiting for surgery generally feel there is nothing to do but wait. In fact the weeks before an operation are an opportunity to measurably reduce complications and speed recovery.
Two changes in particular, stopping smoking and improving fitness, have effects comparable to some medical interventions.
The Pre Anaesthetic Assessment
Before any operation under anaesthesia you will be assessed by an anaesthetist. This is not a formality.
It identifies conditions that increase risk, determines which type of anaesthesia is safest, plans pain relief, and identifies medications needing adjustment.
Bring a complete list of everything you take, including over the counter medicines, ayurvedic and herbal preparations and supplements. Several of these affect bleeding and anaesthesia, and patients frequently do not mention them because they do not consider them medicines.
Mention any previous problems with anaesthesia, in yourself or in blood relatives, and any loose teeth, dentures, or difficulty opening the mouth. Our anaesthesiology department conducts these assessments before planned surgery.
Stopping Smoking Is the Single Biggest Change
Smokers have substantially higher rates of chest infections, wound infections, wound breakdown and heart complications after surgery.
Benefits begin quickly. Carbon monoxide clears within twelve to twenty four hours, improving oxygen delivery immediately. Stopping four to eight weeks before surgery produces the largest reduction in respiratory complications.
Even stopping a few days before helps. It is never too late to be worth doing, and the belief that stopping shortly before surgery is harmful is not supported.
Surgery is also one of the most effective moments to stop permanently, since motivation is high and the hospital stay provides an enforced break.
Prehabilitation: Building Reserve Before Surgery
Fitness before an operation predicts recovery after it. Improving it in the weeks beforehand is called prehabilitation and has good evidence behind it.
- Aerobic exercise: brisk walking most days, building duration gradually
- Breathing exercises: deep breathing and incentive spirometry, which reduce postoperative chest infections
- Strength work: simple resistance exercises to preserve muscle
- Protein intake: adequate protein supports healing and reduces muscle loss
- Correcting anaemia: iron deficiency before surgery increases transfusion need and worsens outcomes, and is easily treated if identified early
- Controlling blood sugar: high HbA1c is associated with more wound infections
Anaemia correction deserves emphasis. It is common, particularly in women, easily identified, and treatable in the weeks before surgery. Ask whether your haemoglobin and ferritin have been checked.
Medications to Stop, Continue or Adjust
Never stop or continue anything on your own judgement. Get specific instructions.
- Blood thinners: require a plan. Stopping them carries clotting risk, continuing carries bleeding risk. Never stop antiplatelets after a recent stent without cardiology advice
- Anti inflammatory painkillers: usually stopped several days before
- Diabetes medications: adjusted around fasting. Some, including metformin and SGLT2 inhibitors, have specific timing rules
- Blood pressure drugs: most continued, though some classes are held on the morning of surgery
- Herbal supplements: many affect bleeding and should be stopped two weeks before
- Steroids: must not be stopped abruptly, and often need a stress dose
- Oral contraceptives and hormone therapy: may be stopped before major surgery because of clot risk
SGLT2 inhibitors deserve particular mention, as they need stopping several days before surgery to avoid a specific metabolic complication during fasting.
Fasting Rules Have Changed
The old instruction to take nothing by mouth from midnight is outdated and causes unnecessary dehydration and discomfort.
Current guidance for most patients is no solid food for six hours before, and clear fluids permitted up to two hours before surgery.
Clear fluids means water, black tea or coffee without milk, and clear juice without pulp. Milk, and drinks containing milk, count as solids.
Some units encourage a carbohydrate drink two hours before, which reduces the metabolic stress of surgery and improves recovery.
Follow your hospital's specific instructions, since they vary, and confirm the timing rather than assuming.
What to Prepare at Home
Recovery is easier when the practical arrangements are made in advance.
- Arrange someone to bring you home and stay the first night after day surgery
- Prepare and freeze meals
- Move frequently used items to waist height to avoid bending or reaching
- Arrange help with children, elderly relatives and household work
- Sort out leave from work realistically rather than optimistically
- For hip or knee surgery, arrange a raised toilet seat and a high chair with arms beforehand
- Fill prescriptions for painkillers in advance
- Prepare a hospital bag with medication list, previous reports, and comfortable loose clothing
Bring your previous imaging and reports. Reconstructing your medical history from memory at admission wastes time and occasionally leads to repeat investigations.
Questions Worth Asking Your Surgeon
Informed consent should be a conversation, not a signature.
- What exactly will be done, and why is it needed now?
- What happens if I do nothing, or wait six months?
- Are there non surgical alternatives?
- What are the specific risks in my case, given my other conditions?
- How long will I be in hospital, and off work?
- Who will actually perform the operation?
- What restrictions will I have, and for how long?
- What are the signs of a complication I should watch for at home?
That last question is the most useful and the least often asked. Knowing what to watch for means complications are caught early.
Reducing Complications Afterwards
Your actions in the first days after surgery matter as much as the preparation.
- Move early. Walking within hours where permitted reduces chest infections, clots and muscle loss
- Do the breathing exercises, hourly while awake, which prevents chest infection
- Take pain relief regularly rather than waiting for severe pain, because pain prevents movement and deep breathing
- Eat and drink as soon as permitted
- Wear compression stockings and take clot prevention medication as prescribed
- Keep the wound clean and dry, and know what normal healing looks like
- Report early: fever, spreading redness, discharge, increasing pain, calf pain, breathlessness or chest pain
Early mobilisation is the single most effective postoperative measure and is frequently resisted because it is uncomfortable. It is worth doing anyway.
The weeks before surgery are useful time. Stop smoking, walk daily, practise breathing exercises, correct anaemia, get clear instructions on every medication, and prepare the house. Those steps genuinely lower your risk and shorten your recovery.
Our general surgery and anaesthesiology departments at T. Nagar run pre operative assessment clinics.
Related Topics
