Surgery - What To Expect

A Guide to Surgery at St. Joseph's Hospital

Table of Contents

General Surgical Information

Preparing for Your Surgery

The Day of Your Surgery

Inpatient Stay

After Your Surgery

General Surgical Information

Patient tracking system

We want to keep you informed at every step of your loved one’s journey with us, from admission to discharge. Through our patient tracking system we can update you on where your family member/friend is via television monitors located in our main waiting areas. Information posters by each monitor explain the meaning of the updates that appear beside their unique case number. For more information, please talk to the admissions team when you are in the hospital.
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Reporting changes to health or medical conditions

Any change in your health or medical condition could affect the care we provide to you during your stay in hospital or in preparation for your surgery.  Please contact your surgeon's office promptly to let them know of any changes in your health or any new medications that you are taking.
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Verification of identification

For your safety you may be asked multiple times to confirm who you are, medical history, such as, allergies, medications, etc. and your procedure. These questions are necessary for individual clinicians to ask as part of your ongoing care.
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Alcohol, drugs, medications and substance involvement

During your pre-surgical screening appointment, you will be asked about your use of alcohol, tobacco, prescription, over the counter medication and non-prescription drugs or psychoactive substances such as marijuana or cocaine. It is extremely important to discuss your use of all psychoactive substances both legal and illegal so that we can plan your care and improve the safety of your surgical experience.  

The use of any of these psychoactive substances can possibly interact, sometimes negatively, with anesthesia or affect how we manage your pain or discomfort after surgery. The improper use of medications or non-prescription drugs may also affect your overall wellbeing or specific body systems such as heart or lungs.  

Hospital employees must maintain your personal health information as confidential and only those team members that are involved with your care have a right to access this information. The hospital has strict policies to protect your privacy.  These policies include the disclosure of information, who is able to disclose and how that happens. 

Together, we can try to achieve the best outcomes of your surgery.  If you have questions about your privacy please speak with your nurse during your interview.
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Anesthesia

Anesthesiology is a branch of medicine dedicated to total care of a patient undergoing surgery or invasive diagnostic procedures.

Anesthesiologists are the only physicians with expert knowledge of the drugs used during surgery to ensure ‘sleep’ and/or absence of pain. Total care also includes preparing you for surgery, being responsible for pain relief in early recovery as well as managing complications that may result from the procedure. Anesthesiologists are familiar with all medical conditions and their implications for patients and are leaders in ensuring safe surgery. They have experience in giving an anesthetic for all surgical procedures and provide care to all ages.

There are several forms of anesthetic care patients receive at St. Joseph’s Hospital:  general anesthesia, regional anesthesia and intravenous sedation: 

General anesthesia is a drug-induced, reversible state of unconsciousness, which provides pain relief and relaxation of muscles, ensuring that patients have no memory of their procedure. 

Regional anesthesia (a specialty at St. Joseph’s Hospital) involves injecting local anesthetics close to a nerve or nerves that supply feeling (and function) to the area of the body involved in the operation. You will often receive sedative medication in addition to your regional anesthetic for your comfort, tailored to your individual needs. Local anesthetic drugs stop nerves from working temporarily, so that no sensation and movement occurs in the area of the body supplied by those nerves. 

Intravenous (or deep) sedation is used for invasive diagnostic procedures, such as a colonoscopy, to provide superior patient comfort but also allow for rapid recovery and return to full function.

With any type of anesthesia, your comfort and safety are the first priority of your anesthesiologist. You will have the opportunity to meet your anesthesiologist who will review your history and answer any questions that you may have prior to your procedure.
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Pre and post-operative exercises

Practice the following exercises three times the day before your surgery so you are prepared to do them after your operation. This instructional video demonstrates how to do the exercises properly. 

Deep breathing exercises – to prevent pneumonia

  1. Breathe in through your nose deeply and slowly.
  2. Blow out slowly through your mouth.
  3. Repeat 10 times. If you get dizzy or lightheaded, pause for a minute, and continue.
  4. After your last breath in, give a good cough (using your abdominal muscles) to clear any mucus.
  5. After surgery, repeat this exercise every hour while you are awake.

Leg circulation exercises – to get your blood circulating smoothly, prevent blood clot formation and restore muscle tone.  See information on next page for further information about venous thromboembolism (blood clots).

Ankle pumping

  1. Point toes of both feet gently away from you.
  2. Flex your feet with toes pointing up.
  3. Repeat 20 times, four to six times a day.

Ankle circles

  1. Circle your feet around your ankles in each direction 10 times.
  2. Repeat four times a day.

Knee bending

  1. Bend each knee, one at a time, sliding foot along the bed toward you and then slide it down.
  2. Repeat 10 times for each leg, four times a day.

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Venous Thromboembolism

Venous thromboembolism (VTE) is a medical term that includes deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is a blood clot that forms deep inside the lower leg and blocks the blood flow.

Signs and symptoms of DVT:

  • Skin feels warm at the site of the clot
  • Veins near the surface of skin appear larger or noticeable at the site of the clot
  • Pain, tenderness or swelling in the leg or calf

PE is a blood clot that breaks off from the wall or a vein and travels through the bloodstream to the lungs and blocks the blood flow

Signs and symptoms of PE:

  • Dizziness/Fainting
  • Sudden sharp chest or upper back pain
  • Shortness of breath
  • Coughing up blood 
  • Fast heart beat

What you can do to prevent the formation of clots

  • Perform the pre and post-operative exercises such as ankle pumping, ankle circles and knee bending as described in on these webpages.
  • Get up and walk at least four times a day for 15-20 minutes, increasing daily
  • Take medication or wear the stockings as prescribed by your doctor

When you should call a doctor

If you have any swelling, redness, tenderness or pain in your leg, call/visit your doctor or your local Emergency Department or Urgent Care facility as soon as possible.

When you should call 911

Call 911 if you have any of the following symptoms:

  • Trouble breathing
  • Sharp unexpected chest pain
  • Coughing up blood
  • Fast heart beat
  • Fainting
  • Worsening of symptoms

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Preparing for Your Surgery

Before surgery checklist 

  • You must plan to have a responsible person accompany you home as you are not able to drive for at least 24 hours after anesthetic. A taxi driver is not considered a person accompanying you home but you may go home by taxi accompanied by an adult friend or family member. A contact number for this person must be provided. (If you do not have a driver to take you home after surgery, please tell your pre-surgical screening nurses and your surgeon.)
  • It is recommended that you have someone stay with you when you get home and overnight.
  • Do the exercises described in this guide three times on the day before your operation.
  • Remove all jewelry including: rings, watches, chains, and piercings.  Piercings in the mouth or nose may become dislodged and could end up in your stomach or lungs. Rings can stop blood circulation to fingers or toes and may need to be cut off during surgery for your safety. If you cannot remove your rings, please go to a jeweler before surgery to have them removed.
  • If you are having upper limb surgery, please have fake nails removed prior to surgery as this can lead to your surgery being cancelled.
  • Take time to plan ahead for after your surgery. For example, you may need to:  
    • Get extra groceries or prepare meals ahead and freeze
    • Have all your laundry done
    • If you aren’t able to drive, arrange for someone to bring you to appointments
    • Arrange for someone to help you around the house if you have restrictions in what you are able to do
    • Think ahead to what will you be able to wear and plan accordingly
  • If you have forms that need to be completed by the surgeon, please call the surgeon’s office to make arrangements for completion prior to your surgery. They are not done on day of surgery.  
  • After surgery, you or your support person will need to take your prescription to a pharmacy. They are not faxed.

Reasons your surgery may be canceled
 

Eating and drinking instructions are not followed

Medications instructions for what to take and stop were not followed

No responsible person to accompany you home (not the taxi driver)

Jewelry/piercings are not removed

Fake nails not removed if you’re having hand and upper limb surgery

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Eating and drinking before surgery 

You are encouraged to drink clear fluids up to three (3) hours before your scheduled surgery time.

Clear fluids include water, apple juice, cranberry juice, broth, Jello, popsicles/freezies, and black coffee or tea with or without sugar/sweetener. NO CREAMER OR MILK.

You may chew gum or consume the occasional mint up to three (3) hours before your scheduled surgery time.
DO NOT eat or drink any solid foods and liquids that are not listed above after 12 am (midnight) the night before your surgery. This includes all food, dairy products and orange juice.

You may get specific eating and drinking instructions that differ from these if your surgeon has ordered them and you will be told these at your Pre-surgical Screening unit appointment.

Your surgery will be cancelled if you do not follow these instructions.

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Medication instructions before surgery 

During your Pre-surgical Screening Unit  appointment, the nurse will provide you with specific instructions on which medications to take the morning of surgery with clear fluids, which medications to not take and which specific medications you should bring with you to hospital.

DO NOT TAKE diabetic pills or insulin the day of surgery - unless told otherwise. 

  • Bring all inhalers and nitro spray with you to the hospital even if having day surgery.
  • If you will be staying overnight in the hospital after your surgery, bring all prescription medications in their original containers, including inhalers, eye drops and creams. 
  • Please note: we do not administer vitamin and herbal products.

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What not to do before your surgery 

  • DO NOT use creams, lotions, or powders on the area of your operation. If you are having upper body surgery, do not use deodorant on the side of your operation.
  • DO NOT shave the area of your operation.
  • DO NOT wear makeup, lipstick, hairspray or perfume/cologne on the day of your surgery.
  • DO NOT drink alcohol or smoke for at least 24 hours before and after your surgery.

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General tips for surgery preparation 

  • Shower or bath the night before or morning of your surgery.
  • Remove nail polish on fingers and toes.
  • Remove contact lenses, hair clips and pins.
  • Wear loose fitting clothing to the hospital such as track pants and sturdy shoes such as running shoes, no flip flops.
  • For hand/wrist surgery, please bring two pillows for the ride home and leave them in the car.
  • If you are having arm/hand surgery, your sleeves should be loose and stretchy we recommend an oversize stretchy t-shirt to fit over bulky dressings.
  • Ophthalmology patients - please wear a short sleeved, button down shirt or loose-fitting shirt.
  • Ask your surgeon for information on costs for services or devices you will need for your surgery and after care not covered by the Ontario Health Insurance Plan, such as casts and slings.

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The Day of Your Surgery

If you are ill or notice a change in your health before your surgery, call your surgeon’s office. 

If you wake up sick the morning of surgery or are unable to come due to weather, please call Surgical Centre registration (admitting) at 519 646-6015 and your surgeon’s office.

When you arrive at St. Joseph’s Hospital for your surgery, please go to Surgical Centre registration (admitting) located in Zone C, Level 1, Room C1-300. 

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What to bring the day of surgery 

  • Discharge instructions you received during your pre-surgical screening appointment
  • Containers for dentures, glasses, and contacts.
  • Hearing aids
  • Your CPAP machine (if you have sleep apnea) and are going to be admitted and stay overnight.
  • Your Ontario Health card (or equivalent).
  • Cell phone or contact information and the number for person driving you home (Please note your cell phone is your responsibility to keep safe)
  • Method of payment for prescriptions if filling at The Prescription Shop
  • If having hand or wrist surgery, bring 2 pillows but leave them in the car for the ride home

Do not bring any valuables with you on the day of your surgery. 
This can include:

  • Jewelry
  • Credit cards
  • Watches
  • Electronic items
  • Large amounts of money
  • Designer handbags/clothing

Day surgery patients: We do store belongings for patients having day surgery in a locker.

Inpatients: For patients being admitted, please have your family/friend bring your belongings AFTER you have been admitted to the inpatient unit. (See Inpatient Stay for what to expect during your stay in hospital).

St. Joseph’s is not responsible for lost or stolen articles.

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Visitors and caregivers

Due to COVID-19, please refer to the COVID-19 pandemic information for patients, families and visitors for up-to-date information:

  • If you are allowed an essential visitor, there is only one visitor allowed at bedside 
  • Please note: children are not allowed in the Surgical Day Care Unit.  

Waiting areas

For those waiting for someone undergoing surgery, the Family Waiting Room in Zone C, Level 1 is staffed by volunteers who can answer your questions. By checking in at the Family Waiting Room or with surgery staff, the surgeon will know where to find you if he/she wishes to speak to you after the surgery.

You will be given a unique case number to track your loved one’s journey through the surgical process on our patient tracking system. Monitors are located just outside our surgery area, in the surgical Family Waiting Room and other main seating areas in the hospital. Once there is an update to the SDCU Post-op Bay # column on the far right of the screen, you can visit your loved one in the bay # listed in the Surgical Day Care Unit located in Zone C, Level 1.

In addition to the surgical Family Waiting Room, there are comfortable chairs located throughout the main lobby area in Zone C and two cafeteria areas:  

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Inpatient Stay

For those requiring an inpatient stay at St. Joseph’s Hospital after surgery, we are committed to providing you with excellent, safe and compassionate care.  After your surgery you will be brought to our surgical inpatient unit located in Zone B, Level 6. If you are staying with us over the weekend (Saturday evening through to Monday morning) you will be moved to our G.A. Huot Surgical Centre located in Zone C.

Your care team

In our surgical inpatient unit, our multi-professional teams include: a physician, nurse, attendant, nursing unit secretary, physiotherapist, occupational therapist, social worker, dietitian, and chaplain from Spiritual Care.  

Your surgeon’s team of residents makes rounds at 6:30 am. If you have questions, it helps to write them down so you don’t forget them.

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Clinical handover 

Clinical handover is when care of a patient is transferred from one staff member to another. During this process, communication of essential patient information is shared between the patient, family members, and clinical team. The goal of this process is to ensure patient care needs are met while maintaining patient safety and providing an opportunity to ask questions. Clinical handover ensures the right information gets to the right staff at the right time. If you have any questions about this process, please ask a member of your care team.

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What to bring for an inpatient stay

  • Bring one small bag or suitcase with essential items such as:
    • Slippers with non-slip soles and robe
    • Medications as discussed during your pre-screening appointment
    • Reading glasses
    • Hearing aids with extra batteries
    • Toiletries – toothbrush, toothpaste, mouthwash, brush/comb, shaving cream, lotion, razor or shaver, shampoo, body wash, soap
    • Tissues
  • Your Ontario Health Card (OHIP)

Do not bring:

  • Cash
  • Credit cards
  • Driver’s license

For security reasons, your support person needs to keep your belongings until you are taken to your room after surgery. If you are by yourself, we will take care of your bag for you. Please label your bag or suitcase with your name. 

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Cable television and Internet access

The inpatient unit has two lounges with cable television, or individuals can use their own personal devices by purchasing wireless internet access.  Free wireless internet access is available. To instantly access the Internet, connect your device to the wireless network called: St. Josephs Guest.  

If your stay extends over the weekend, you will have access to one of five televisions with cable. 

Throughout St. Joseph’s Hospital, cellphones, laptops and other electronic devices are allowed in designated areas only. Look for green cellphone signs in main lobbies, cafeteria, etc.

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Discharge

It is your responsibility to plan for your discharge. You will need to arrange your ride home and your ability to care for yourself at home.  

Discharge time is between 11 am and 1 pm, depending on your type of surgery and post-surgical care. Please ensure your ride and support person is available within that window. Your inpatient nurse will confirm your discharge time with you.

If your care requires you to stay over the weekend a member of your clinical team will explain the arrangements.

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Keeping families updated

We recognize that family members want to stay up to date on your progress. We ask that one person be designated to call for updates, which they can then share with other family and friends as appropriate. This will prevent multiple disruptions in the provision of patient care.  

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Inpatient unit visitors

Preferred visiting hours are 11 am to 8 pm. One visitor at a time is permitted, in consultation with the care team.  

If you are an inpatient over the weekend, please discuss visitor hours and restrictions with your nurse, particularly if your stay is in the Post Anesthetic Recovery Unit

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Cafeteria and Tim Hortons

There are two locations for food and refreshments at St. Joseph’s Hospital. 

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Other services

For information and directions for our Prescription Shop, gift shop, chapel and parking, visit St. Joseph's Hospital | St. Joseph's Health Care London

We would like your feedback

We hope your time with us is as comfortable and pleasant as possible. To help us evaluate the care and services we provide, we encourage you to complete a patient comment card or provide feedback online at Feedback | St. Joseph's Health Care London

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After Your Surgery

You must have an adult take you home by car or accompany you in a taxi. A taxi driver does not constitute a responsible accompaniment. St. Joseph’s strongly recommends that outpatients have a responsible person to stay with them overnight, however, this is no longer mandatory. It is safer for you to have someone overnight but we recognize that this is not always possible. If your surgeon advises you that you must have someone stay with you overnight because of the nature of your surgery – this will be a requirement of your care. Please discuss any concerns with your care team. 

It is important that you and your driver may have an extended stay based on the need to be seen after your surgery by physiotherapy or by your surgeon. For example, ophthalmology patients may have a follow up appointment later in the day or you will need to leave and return. It is important that you plan for the extra time that you may be at the hospital. 

For teaching with physiotherapy, the person supporting you at home is requested to be present during the education and may have a wait after being called to the hospital.

Remember to do your post-operative exercises. These exercises are important to prevent a venous thromboembolism or blood clot from forming when you are more sedentary. 

How to care for your surgical site 

  • Check your dressing for signs of excessive bleeding (slow oozing that completely soaks your bandage within one hour).
  • Do not soak your wound/incision in water.  If the bandage gets wet, change the dressing, using sterile gauze and tape unless told otherwise. Wash your hands before and after.
  • You may need to purchase the dressings and tape required to change your dressing.
  • Once your dressing has been removed you may shower and get the incision wet.  Soap will not harm your incision.  Gently pat the incision dry. 
  • Do not apply oils, creams, lotions, or powders to your incision, unless instructed.
  • Follow your discharge instructions for more specific information

What not to do after your surgery 

Dizziness, drowsiness, light-headedness are common symptoms after anesthetic. 

For at least 24 hours after your surgery do not:

  • Drive a vehicle of any kind or do any tasks that require skill, coordination, and judgment. (Note: if you have had limb surgery, do not drive until you are advised by your surgeon.) Anesthesia and pain medication impair your judgment and reactions
  • Operate machinery or power tools
  • Handle dangerous items like hot grease, boiling water
  • Drink alcohol or take sedatives/tranquilizers
  • Smoke
  • Make important personal or business decisions, or sign important documents
  • Take part in sports, perform heavy work, or lift heavy objects

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Common side effects after surgery and what to do 

Nausea and vomiting 

  • Severe pain after surgery can cause nausea. Help control your pain by following the instructions below:
  • Remember to take your prescription pain medication with food.
  • Reduce your prescription pain medication use when able. 
  • Prevent dehydration by eating ice chips or taking frequent small sips of water, weak tea, or clear flat soda (every 15-20 minutes).
  • When vomiting has stopped, try a bland diet for the next 24 hours (soda crackers, Jell-O, popsicles, toast, eggs, rice, and chicken).
  • Avoid dairy products, caffeine, alcohol, nicotine, and fatty or highly spicy foods.
  • Decrease motion.
  • Use an anti-nausea medication, Dimenhydrinate (Gravol) by mouth or rectum (suppository) 20 to 30 minutes before taking pain medication (can be bought without a prescription).
  • Contact your surgeon if you cannot keep any fluids down for 24 hours even with the use of Dimenhydrinate (Gravol).

Constipation

  • Increase dietary fiber to 20-35g daily, (fruits, vegetables, bran, prunes). 
  • Drink at least six to eight (eight oz.) glasses of fluids daily, (water, milk, juices (prune, orange), and soup).
  • Eat a variety of fruits and vegetables when able.
  • Reduce sugar and fat intake.
  • Reduce use of pain medications when possible.
  • Increase daily activity gradually, starting with 15- to 20-minute walks in your home every two hours while awake.
  • Maintain normal bowel routine.  Don’t rush having a bowel movement. 
  • Use stool softeners when needed, as directed by your surgeon (Colace, Soflax).  
  • If your bowels have not moved in two days after surgery, use a mild laxative (Milk of Magnesia).

Sore throat, hoarseness, cough
Patients can experience a sore throat, hoarseness or cough after surgery caused by irritation to the back of the throat by the breathing tube that was used for the operation. Sore throats usually last one or two days after surgery. 

To ease these symptoms, you can:          

  • Use Cloraseptic throat lozenges or over-the-counter antiseptic sprays – consult your Pharmacist. 
  • Increase fluids (cool liquids, ice chips, popsicles) tea with honey may help soothe.          
  • Warm salt water gargle (one teaspoon of salt in an eight oz. glass of warm water) or 1 tsp baking soda mixed with warm water (1/2 cup), gargle and spit out. Do not swallow.
  • Avoid spicy foods or acidic juices (orange, tomato).                                                                          
  • Avoid smoke.  
  • Humidifier use may be helpful.
  • If your symptoms do not improve or get worse, call your family doctor or primary care provider.

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Watch for these warning signs 

Call your surgeon and go to the nearest Emergency Department or the Urgent Care Centre at St. Joseph’s Hospital if you have any of the following symptoms:

  • Redness, swelling, or drainage from your wound.
  • Fever of 38.5C (101F) or greater, or chills, lasting longer than 24 hours.
  • An increase in pain that is not relieved by your pain medication. 
  • Vomiting lasting longer than 24 hours without relief from Dimenhydrinate (Gravol).

IF YOU NEED IMMEDIATE ASSISTANCE - CALL 911.

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Eating and drinking after surgery 

After your surgery you should begin with eating light foods such as crackers, Jell-O and soup. Increase gradually to a normal diet. If you are not nauseated 24 hours after surgery you can begin your regular diet, unless advised otherwise. 

Avoid spicy, greasy, fried foods and large portions for 24 hours as they can cause gas, indigestion, and heartburn. Drink six to eight (eight oz) glasses of fluid daily, taking small sips often. Good choices include 
ginger ale and water.

Please note: follow the directions above unless you have received specific instructions from your surgeon.

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Activity after your surgery

No matter what type of procedure you have, remember, surgery can have significant mental and physical effects. You will tire easily after your surgery so ensure that you rest for the remainder of the day and give your body and mind a chance to heal.

  • Increase activity gradually. Start with short 15-20-minute activities like walking every two hours while you are awake for the first one to three days. 
  • Getting up for meals is a good introductory activity.
  • Limit naps to 30 to 60 minutes a day so that your night time routine is not affected.
  • Sexual activity may be resumed when comfort permits, unless told otherwise by your surgeon.

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Patient Rights and Responsibilities

WHAT ARE YOUR RIGHTS?

Patients have the right to privacy.

All patients have the right to understand how St. Joseph’s collects, uses and discloses their personal health information. Patients, residents, substitute decisions makers (SDM), families and care partners can find information on privacy as follows:

Patients have a right to share complaints and concerns, including safety concerns.

All patients, residents, SDMs and family caregivers have the right and are encouraged to share their feedback including compliments, complaints and safety concerns. Patients can do this by:

  • Calling Patient Relations at 519 646-6100 ext. 61234 
  • Emailing Patient Relations at @email
  • Filling out a comment card available throughout our various sites. The comment card can be left in the drop boxes located near hospital entrances or mailed directly to Patient Relations
  • Submitting an on-line submission via Contact Patient Relations found on the St. Joseph’s website
  • Sharing their concern with a member of their clinical team

All complaints and concerns are acknowledged within two business days whenever possible, and no longer than five business days, in keeping with the Excellent Care for All Act.

Patients, residents, substitute decision makers, families and care partners have the right to be treated respectfully and appropriately.

Patients/SDMs and residents have the right to actively partner in their care, be treated with dignity and respect, and to feel confident in the care they receive.

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    Dr. Sosoo