So your doctor has recommended surgery what happens next?

Usually Sweety our secretary will make contact with you directly to confirm we have received your referral. She will sound you out whether you would appreciate a full consultation in our rooms prior to any planned surgery or whether you are comfortable with organising a date for surgery and having that full consultation the afternoon/ evening before surgery on the surgical ward.

As part of that consult we will take a complete medical and personal history not just limited to your surgical problem. A complete list of your current medication and any important allergies, previous surgeries is helpful. But we will also enquire about any smoking or alcohol history and a general systems enquiry. We will then conduct a brief but complete examination of your lung and cardiovascular system.

The exact planned operation will be discussed with you and your family and importantly include a discussion of our perceived risks of surgery as they relate to your particular circumstances. You and your family are encouraged to ask any questions you may have – we would much prefer to answer these before the operation, if possible. We believe it is crucial that you and your family are clear about why surgery has been recommended, what operation is proposed, the likely benefits of that surgery and importantly any significant anticipated risks. We discuss risks , not trying to frighten you , but hopefully in fact to reassure you or at least have them put into perspective since we want you and your family having the same understanding as us.

Prior to any planned surgery, Sweety will help you negotiate your way through prior approval with your insurer, including a cost estimate, and or the deposit of funds into the MercyAscot account if you hold no insurance. Surgery requires you to be admitted to St Anne’s ward at the MercyAscot Hospital, Epsom by 1400 the day before surgery. A blood test will be drawn if necessary, chest X-ray and an ECG taken usually. Please bring with you any relevant chest X-rays, scans and all your current medication. A nurse will admit you to the ward and show you around including where the Intensive Care Unit is. You will have an appropriate shave of any surgical sites with an antibacterial wash.

You will be seen by your surgeon who will sign the surgical consent form with you and offer to answer questions even if previously done. It’s a good time for family to also be introduced to your surgeon if they have not already met.

That consent form will:

•  detail the operation
•  document which side if relevant
• contain approval to draw off any necessary blood tests in the event of an accidental needle injury to staff
• enable you to request any relevant tissue to be returned to you after its pathological examination.

You will also meet with your anesthetist who will discuss the necessary aspects of anesthesia, including any risks and invite you to sign the anesthetic consent form. Usually, this same anesthetist will be responsible for you if you are in either the intensive care or HDU unit following surgery. Where relevant, you will also be introduced to your perfusionist for the following day.

On the day of surgery we will contact your designated family member or friend to inform the surgery has been completed, what procedure was performed and the reasons for any change along with a description of your general condition. We welcome family to visit you even if in intensive care and will update the family of any significant change in your condition. We welcome questions as we would prefer to have you and your family fully informed of your current status. Your surgeon will visit often twice a day so there is plenty of opportunity to meet and talk with family.

When ready for discharge, you will leave the hospital with your X-rays, medication and a handwritten discharge letter with a dictated letter being later provided to both your specialist and general practitioner. As a general rule of thumb, we strongly recommend you see your general practitioner 1 – 2 days after discharge. This lets them catch up with the fact you have had recent surgery, your state at the time of discharge and any particular concerns during your admission and can form a reference for any necessary consults. There may well be stitches that need removing and there are always wounds that need review. Usually, we will organize a follow-up at an appropriate time frame – 4 – 6 weeks for heart and major lung surgery, earlier for more minor surgery. We normally recommend that you make your own arrangements to be reviewed by the doctor who originally referred you for the procedure after you have seen us, typically 6-8 weeks after surgery.

The results of surgery and in particular the results from any cancer related resections can be relayed to you via telephone. We acknowledge this is not ideal but for practical purposes where you want to know the results as soon as possible this is the only practical solution. If you wish to meet with us in person to hear these results we will endeavor to make this possible.