Risks of ‘General’ Surgery

Pre-operative Investigations As mentioned above, you may be required to have some investigations before your surgery. This could include certain blood tests, mammography, chest x-ray, ECG or ultrasound relating to pre-existing conditions – the investigations will depend on the procedure you have chosen. The cost of these investigations is not included in the fee structure – your patient coordinator / nurse will advise you of any extra fees incurred. One Health only covers MRSA testing preoperatively for 1 screen only and standard profile blood samples where required.

Transport & going home from the hospital Please make sure that you arrange for a relative or friend to collect you from the hospital as patients will not be discharged without a chaperone and in the instance of Vaser, a chaperone is required on admission too – if you need assistance in arranging transport to and/or from the hospital please speak to your patient coordinator. You will not be able to drive home following your surgery regardless of the type of surgery you have undergone. It is also inappropriate for you to take public transport to get home even if accompanied by a relative or friend. It is also required that you arrange for a responsible adult to be with you for 24 hours after your surgery. In the interests of your safety ONE HEALTH may consider postponement or cancellation of your surgery if you are unable to arrange this and this will affect your terms and conditions. Please note that it is important that you prepare to be within 1 hour of the hospital where your operation will take place on the first night of your procedure so you can return if required.

What to pack for your hospital stay You will need a small overnight bag with some basic requirements including: § toiletries § nightwear § slippers or soft footwear § any medicines you are currently taking and § loose comfortable clothing to wear on your journey home § the instructions and information given to you by the clinic nurse and patient coordinator relating to your operation § a book or magazine Please note that neither One Health nor the hospitals we use are able to take any responsibility for your valuables or cash that you may take to the hospital.  It is highly recommended that you ensure that any unnecessary items are left at your home. However, if you decide to take items of this nature with you please advise the hospital and arrange to arrange safe keeping.

“IMPORTANT” – Preparation for your operation…
Please note that your admission time is not your operation time, you will have a long wait from admission to operating time as the hospital undertake a series of admission checks and tests before you can have your procedure. It is vital that you do not expect to be operated on immediately. This can be anything up to 8 hours wait.

Prior to your admission to hospital you will be given this written information: 1. One Health’s General Cosmetic Surgery Guide 2. One Health’s Information Sheet relevant to your procedure 3. Any special information given to you by your surgeon

For your wellbeing and safety during your operation it is important that you consider the following: § DO NOT apply false tan for a period of for 7 days prior to your operation  § DO NOT apply any moisturiser to your skin for a period of 24hrs prior to your operation § DO NOT drink alcohol 48 hours prior to your surgery (in the case of major procedures you will have more specific instructions) § PLEASE REMOVE all false eyelashes and/or nails, makeup and piercings before your admission to hospital § Hair extensions will need removing if they contain any form of metal or copper § shower on the morning of your operation using an antibacterial shower gel § DO NOT apply deodorant after your shower or moisturiser to any part of your body as mentioned above § PLEASE tie up your hair if it is long  § PLEASE wear loose fitting clothes to the hospital that button up at the front so that you can change easily before and after your operation § advise your nurse before your surgery if you think you may be pregnant
Informing your GP As your GP is responsible for your general healthcare it is important that you inform your GP about any intended surgery. You will be asked to complete this information at your first appointment with ONE HEALTH and we will write to them to ensure you are fit for elective surgery and anaesthesia. Failure to supply this information will result in ONE HEALTH cancelling your procedure and this will affect your terms and conditions. ONE HEALTH has a duty of care to notify your GP.

Smoking and Use of Nicotine Patches Smoking prior to your surgery can increase the risk of anaesthetic complications.  Smoking both prior to and post surgery also increases the risk of wound infections.  The chemicals found within a cigarette deplete the healing cells of oxygen leading to delayed and impaired wound healing.  The chemicals found in Nicotine patches work similarly to those in cigarettes.
ONE HEALTH recommends you stop smoking and do not use nicotine patches in the weeks prior to any surgery and until you are fully healed after your operation.  Your surgeon or anaesthetist has the right to postpone or cancel your operation if this guidance is not followed.
Eating and Drinking: § DO NOT have any food, milky drinks or chew gum 6 hours before your admission to the hospital § YOU MAY drink still clear water up to 2 hours prior to your admission § DO NOT drink water after the two hour limit (In the interests of your safety your operation may need to be postponed if this guidance is not followed)

After your surgery…
For your safety you will be asked to:
§ Please attend all appointments made for you; failure to attend can affect your aftercare and your warranty § please keep the post-operative information you have been given by ONE HEALTH for reference following your surgery should you encounter any problems § during office hours (9.30am to 5.30pm) if you have any concerns or there is any emergency please call your ONE HEALTH Clinic and ask to speak to the nurse § outside office hours in the case of an emergency (bleeding, pain of any other major concern) please call the number listed on the ONE HEALTH Emergency Contact Card § It is important that you keep this card with you at all times § A registered nurse is available 24 hours a day and if required your surgeon will be contacted. § Please note, 24 hour care is over the telephone and not in person; if a situation arises out of hours you may be advised to attend A&E.
General Side Effects and Complications of Surgery and Anaesthesia . . . Side effects and complications can be separated into two areas; one relating to the surgery and the other one relating to the anaesthetic. The following information is for your guidance and further understanding – specific concerns/issues will be discussed with you by your surgeon or anaesthetist.  If you have any questions relating to anaesthesia we recommend that you ask the anaesthetist at the hospital.

Pain after Surgery The majority of patients feel some pain or discomfort following surgery. The amount of pain or discomfort you may experience will depend upon several factors: the type of procedure; the incision and your pain threshold. It is important that you are as pain free as possible to enable you to move around as soon as possible/appropriate, after your surgery. If you find that the pain relief you have been prescribed is insufficient inform your hospital or clinic nurse after your discharge immediately. Your anaesthetist or surgeon will prescribe some pain killers for mild to moderate pain relief to take home with you. The nurse at the hospital will give you your prescribed medicine before you leave the hospital and provide you with verbal and written instructions.

Bruising, Swelling and Bleeding All surgical procedures cause a varying amount of bruising and swelling around the operating site ranging from quite light to quite severe. The outcome of your operation may be difficult to establish for some time due to the swelling and bruising. Don’t hesitate to discuss the expected time for the swelling and bruising to disappear with your surgeon or nurse.  Bleeding around the area of the operation is not uncommon.  However, the amount of bleeding should not be so much as to make you concerned. During your initial post operative period, the hospital nurse will check the operation site for any signs of bleeding and if this occurs will inform your surgeon immediately. If you find that bleeding continues/commences after you have gone home contact the ONE HEALTH nurse immediately.  Full details of this information will be given to you by the ONE HEALTH nurse at your pre-operative assessment.

Infection Any surgical procedure will include the small but important risk of infection at the operation site. This infection may be due to the introduction of bacteria from your own skin during the operation, or the surrounding environment.  Following your operation if any infection results it would mean that you may experience: a high temperature; feel generally unwell; tiredness/listlessness; redness and swelling around the incision site. Please contact your clinic or the ONE HEALTH emergency call number provided in the post operative information leaflet.
Scarring All surgical procedures cause scarring to some degree. Surgeons strive to minimise the risk of visible scars. However, this is not always possible. Scars normally reduce in time.  If they remain unsightly they can be treated. People with darker skins have a tendency to form a thick scar – something that you may have noticed in the past. If you feel that your skin does scar easily, please inform your surgeon of this at the time of your consultation. This is important.

Numbness or altered skin sensation It is not uncommon for people to have numbness and altered sensation around the surgical site for some time after the operation. This will normally subside in time.  However, a small number of people continue to have a small area of numbness indefinitely.

Deep Vein Thrombosis and Pulmonary Embolism All surgical procedures carry the risk of a rare but potentially dangerous complication known as Deep Vein Thrombosis (DVT).  DVT involves the development of a blood clot, most commonly in the calf area. In a very small number of cases, the blood clot may move and enter either of the lungs which causes a severe and potentially life threatening blockage of blood supply to the lung/s. When you are being treated at the hospital additional measures are taken to reduce the risk to this condition – use of special tights and post operative exercise/s. The Department of Health advises that post operative patients do not travel on short or long haul flights for a specific period of time (4 weeks short haul and 6 weeks long haul).  ONE HEALTH patient information leaflets and your surgeon will provide specific information.
Anaesthesia

The type of anaesthesia you are given relates to the procedure you are having and the agreement that you make with the anaesthetist before your operation.  Modern anaesthetics mean that severe side effects and complications are rare. The medical team at the hospital have protocols in place to minimise any side effects or complications. However, it is important that you understand that some side effects may occur.  The most common are listed below.  If you have any questions, please do not hesitate to speak with your anaesthetist when he/she visits you in the hospital prior to your operation to examine you and to discuss your procedure, any previous anaesthetics you have had and the method of anaesthetic proposed for your procedure. The most common side effects and complications which may occur are listed relevant to which type of anaesthetic: § General anaesthetic GA § Local anaesthetic LA

Common side effects and complications of anaesthesia
Feeling sick and vomiting after surgery   GA LA   Some operations and anaesthetic and pain-relieving drugs are more likely to cause sickness (nausea) than others. Sickness can be treated with anti-vomiting drugs (anti-emetics), but it may last from a few hours to several days.
Sore throat      GA If you have had a tube in your airway to help you breathe, it may give you a sore throat. The discomfort or pain lasts from a few hours to a few days and can be treated with pain-relieving lozenges.
Dizziness, blurred vision     GA LA  Your anaesthetic or loss of fluids may lower your blood pressure and make you feel faint in the hospital. You may be given a drip to treat this.
Shivering      GA LA   This may be due to you getting cold during the surgery, to some drugs, or to stress. The hospital staff will ensure that you are kept warm if this occurs.
Headache      GA LA   This may be due to the effects of the anaesthetic, to the surgery, to lack of fluids, or to anxiety. The headache usually gets better in a few hours and can be treated with analgesics.
Itching       GA LA  This is a side effect of opiates (such as morphine) but can also happen as an allergic reaction to drugs, sterilising fluids or stitches.  If you have itchiness, it can be treated with other drugs.
Aches, pains and backache    GA LA During your operation you may lie in the same position on a firm operating table for a long time. Great care is taken to position you, but some people still feel uncomfortable afterwards.
Pain during injection of drugs    GA LA Drugs used may cause some pain or discomfort when they are injected.
Bruising and soreness     GA LA This may be caused around injection and drip sites by a thin vein bursting, movement of a nearby joint, or infection. It normally settles without treatment, but if the area becomes uncomfortable, the position of the drip can be changed.
Confusion or memory loss    GA This is common among older people who have had an operation under general anaesthetic. It may be due to several causes. It is usually temporary, but may last a few days or weeks.

After your operation . . . Immediately following your operation you will be taken to the recovery room, where you will spend some time being closely monitored until you are fully recovered from the anaesthetic.  During this time your anaesthetist and the hospital recovery nursing team will ensure that you are comfortable and your pain is controlled before you are returned to your room. It is important that you let the team know if you feel that your pain is not well enough controlled. On your return to your room, you will be cared for by nurses experienced in caring for patients who have undergone cosmetic surgery. During this time, you will continue to be monitored closely and your surgical site will be inspected regularly.

The time that you are discharged from the hospital will depend upon the type of surgery you have undergone and the time of your procedure.  Your surgeon or the hospital doctor will visit you after the procedure and advise when you will be ready for discharge from hospital.

You may also be given medications to take at home.  The hospital nurse will give you the relevant instructions regarding how the medicines should be taken.  During your pre-operative assessment with the ONE HEALTH nurse a post-operative appointment will be made for you to visit the clinic so the ONE HEALTH nurse can check your wound and undertake any instructions that the surgeon may have made.  This will normally be between 2 – 14 days after your surgery (dependent on the procedure).  Your surgeon will also wish to see you post operatively.  It is very important that you attend the appointments with the nurse and surgeon so that you can be carefully monitored.  A member of the ONE HEALTH team will call you at home after your surgery to check your condition.  You will also be given an Emergency Contact Card with a contact number should you experience any problems and wish to speak to a nurse in the case of an emergency.  You are welcome to call your patient coordinator at any time if you have any queries.