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Pre-Op Information

Welcome

The Center for Spine Care surgical team is dedicated to providing the best care for our patients. We take pride in providing personalized care for our patients and their families. Please notify our staff if there is anything we can do to make your surgical experience a better one.

The following information is provided by and intended for the use of patients undergoing surgery at the Center for Spine Care. Please direct any specific questions not answered in the followingpages to your surgical team.

Pre-Admission Packet

All patients will be given a Pre-Admission Packet. Each packet includes: Admission Orders, Medical Records, and Consent Forms. We request that you bring this packet to the hospital registration on the day of your pre-op evaluation. Please keep the "Surgery Instructions" available for your reference.

Preoperative Evaluation

Preoperative Medical Clearance

Prior to having surgery you will be evaluated for routine medical conditions which could affect the success of your elective surgical procedure. You will be evaluated according to your past medical history and proposed surgical procedure. You may be scheduled for this consultation with one of our Certified Physician Assistants or with one of our local Internal Medicine Physicians. If you have had a comprehensive History and Physical Exam with in three months of your proposed surgery, please notify our surgery coordinator. If you have a family physician that has hospital privileges we will be happy to facilitate an appointment with that physician prior to your surgical procedure. Below you will find a list of physicians who continue to provide excellent care to our patients in the perioperative period.

Internal Medicine Physicians:

Scott Fitzgerald, M.D.
5575 Warren Parkway
Frisco, TX 75034
214-221-6362

Irwin S. Korngut, M.D.
8220 Walnut Hill Lane, Suite 110
Dallas, TX 75231
214-739-5505

Charles Natalizio, M.D.
4001 W 15th Street, Suite #480
Plano, TX 75093
972-867-1800

Adrian H. Nguyen, M.D.
3900 West 15th Street, Suite #205
Plano, TX 75075
972-398-7891

Dallas Internal Medicine Group
8230 Walnut Hill Lane, Suite 410
Dallas, TX 75231
214-346-0602

Preoperative Diagnostic Testing

Current guidelines of preoperative evaluation suggest the following:

• Chest X-Ray - Recommended for all patients over 40 years of age or with a history of pulmonary disease, pneumonia, or tobacco use.
• EKG - Recommended for all patients over 40 years of age or earlier in those patients with a strong family history of cardiac disease.
• Cardiac Stress Test - Recommended for those patients with known or newly diagnosed cardiac disease.
• Serum Pregnancy Test - Recommended for all female patients of child bearing age to avoid fetal injury from medications used during surgery.
• Electrolytes - Recommended for all patients to evaluate pre-operative kidney function and glucose abnormalities
• Complete Blood Count (CBC) - Recommended for all patients to evaluate for possible infections, anemia, polycythemia, or hemoglobinoppathy.
• Coagulation Tests - Recommended for patients with history of coagulopathy (e.g. Liver disease, malnutrition) or when a patient is taking certain medications that thin the blood (e.g. coumadin, heparin, NSAID's).
• Urine Analysis - Recommended for patients undergoing surgery involving the implant of medical devices including pedicle screws, metal interbody cages, or other implanted devices to evaluate for occult urinary tract infections.
• DEXA Scan - Recommended for patients over 50 years of age with a history of osteopenia or osteoporosis undergoing fusion surgery to evaluate bone density.
• Psychological Evaluation - Recommended for those patients with a history of a psychological disorder, chronic pain, and/or those patients with a workman's compensation injury.Medications
• STOP TAKING ANTI-INFLAMMATORIES 10 DAYS BEFORE SURGERY. These medications can cause anti-platelet activity, thus cause excessive bleeding during surgery. This is a partial list anti-inflammatory medications; Advil, Alleve, Aspirin, Bextra, Celebrex, Lodine, Mobic, Motrin, Naprosyn, Relafen, and Vioxx.
• STOP TAKING ANTICOAGULANTS 5 DAYS BEFORE SURGERY. These medications such as; Coumadin, Fragmin, Heparin, and Lovenox can increase intraoperative bleeding. Consult the prescribing physician for further information on stopping these medications.
• STOP TAKING MONOAMINE OXIDASE INHIBITORS 2 WEEKS BEFORE SURGERY. These medications such as: St Johns Wart, Nardil, and Parnate tablets are often used to treat depression, and can cause harmful interactions with anesthetic agents.
• STOP TAKING HERBAL MEDICATIONS: Some herbal medications contain stimulants, steroids, monoamine oxidase inhibitors, and may affect cardiac activity. The following list of herbal medications should be stopped two weeks prior to surgery: St. John's Wart, Kava, Ginkobaloba, Gensing.

Risk Factors for Increased Complications:

This is a partial list of the major risk factors that can affect the surgical outcome. If you have any specific questions regarding your perioperative risk factors, please contact the Center for Spine Care or your Primary Care Provider.

Smoking

• The risk of postoperative pneumonia is two times greater in smokers than in nonsmokers.
• Smokers have a significantly higher rate of non-union (failure of bone healing) than nonsmokers.
• Smokers tend to bleed more during surgery than nonsmokers.
• Patients who have quit smoking for at least 8 weeks preoperatively have improved surgical outcomes.

Diabetes

• Patients with diabetes are at increased risk for; infection, poor healing, renal failure, silent myocardial infarction, gastroparesis, neuropathy, and postural hypotension.

Morbid Obesity

• Morbid obesity is associated with increased risk of blood clots, infection, and post-operative seroma, difficulty with breathing and difficulty with early mobilization.

Advanced Directives:

Advance directives are recommended for all persons not just those undergoing surgery. The wishes of the patient and family regarding resuscitation should be discussed and written down. For more information on advance directives you can contact your local hospital, library, or attorney. There are many computer programs that can help you through this process as well.

THE NIGHT BEFORE SURGERY

Things to do:

• No eating after midnight the night before surgery.
• Pack your overnight bag if necessary (toiletries, extra comfortable loose fitting clothing)
• Remember to leave your jewelry and valuables at home or in another safe place.
• Put all of your medications in a bag and have them available with you the morning of surgery.
• Make sure you have directions to the hospital.
• Set your alarm clock.
• Have a good nights rest.

Anesthesia

The anesthesiologist will usually call you at home the night before surgery to discuss any questions and concerns you may have regarding anesthesia. They will also ask about your past medical history. Occasionally the anesthesiologist will wait and address these matters on the morning of surgery.

Directions

For a map and directions just click on the facility;

Presbyterian Hospital of Dallas
8200 Walnut Hill Lane
Dallas, TX 75231
(214) 345-6789

Presbyterian Hospital of Plano
6200 w. Parker Road
Plano, TX 75093
(972) 981-8000

Texas Institute for Surgery
at Presbyterian Hospital of Dallas
7115 Greenville Avenue, Ste. 100
Dallas, TX 75231
Phone: 214-647-5300
Fax: 214-647-5301

Baylor Regional Medical Center at Plano
4700 Alliance Blvd.
Plano, Texas 75093
(469) 814-2000

Baylor Medical Center at Frisco
5601 Warren Parkway
Frisco, TX 75034
(214) 618-2000

The Day of Surgery

Good Morning!

Your "Surgery Instructions" provided for you contains a date and time for you to arrive at the hospital or surgery center.

Clothing/ Hygiene:

• It is a good idea to shower/ bathe the morning of surgery. This will help decrease the bacteria on your skin and reduce the chance of infection.
• You may brush your teeth the morning of surgery. Be sure not to swallow any water.
• Wear loose comfortable clothing.
• Avoid the use of perfumes and cosmetics.
• Food:
• Do not eat anything.
• Do not drink anything.
• You may swallow a small sip of clear water with your morning medications if instructed to do so.

Last Minute Questions?

The Center for Spine Care surgical team will be available for questions prior to going back to the operating room. If you have specific questions write them down so you don't forget them.

At the Hospital

The Nursing Staff

The nursing staff is available for your safety and care. Please feel free to ask your nurse for those things that can make your recovery as pleasant as possible. We have provided the nursing staff a list of orders that have medicines for almost every symptom you could develop. Just ask your nurse for assistance.

Pain Medication

All patients will receive pain medication. Most patients will have a PCA (patient controlled anesthetic). This is a device where the patient can push a button and receive pain medicine up to every ten minutes until comfortable. On a case-by-case basis, some patients may receive an epidural device for pain control. We will adjust each patient's pain meds depending on their requirements. Occasionally we will have a pain management physician involved to manage these medications.

Physical Therapy

You will receive physical therapy daily while in the hospital unless otherwise notified. Ask for pain medication or push your PCA button 30 minutes prior to physical therapy, this will help you participate.

Prevention of Deep Venous Thrombosis

In order to prevent deep the chance of deep venous thrombosis (blood clots) we have each and every patient wear compression stockings and sequential compression devices. We also will have physical therapy work with each patient for early mobilization.

Prevention of Infection

In order to prevent the chance of infection all patients will receive antibiotics through their IV at the time of surgery.

Prevention of Pneumonia

In order to prevent pneumonia we encourage the use of incentive spirometry. A nurse or respiratory therapist will instruct you on how to do this. It is important to use the incentive spirometer or deep breathe then cough ten times per hour while awake. Get out of bed, the more activity, the more deep breathing you do.