8 weeks before surgery
- Stop smoking 8 weeks prior to surgery or sooner if directed by the surgical team.
2 weeks before surgery
- Stop taking all blood thinning agents including aspirin, ibuprofen, motrin, naproxen, naprosyn (NSAIDs)
- No alcohol consumption. Dr Li has found that patients drinking alcohol have a tendency to bleed more during surgery.
- Stop taking all supplements and herbal supplements 2 weeks prior to surgery including fish oil, vitamins (E, C, K, B), green tea, ginseng, ginkgo biloba, St. John’s Wort
24 hours before your surgery
- Shower and wash thoroughly with an antibacterial soap (see Hibiclens section) on the night before surgery.
Midnight on the evening before your surgery
- Take nothing by mouth after midnight on the evening before surgery (including water, gum, candy, breath mints, etc.)
What not to bring to surgery
- Leave all jewelry and valuables at home.
- Remove all metal hair extensions
- Remove all body piercings. Metal jewelry can conduct electrical energy from the surgical cautery (“Bovie”) and may increase the risk of skin burns. Please take out all piercings at home before arriving for surgery.
- Do not wear contact lenses into surgery
What to bring to surgery
- Wear loose-fitting clothing that is easy to get into. For example, clothing that buttons or zips up the front.
- Arrange for someone to drive you home (No Lyft, Uber, or Taxi) and for someone to help you at home for 1-2 days after surgery. If you have small children, arrange for someone to help you for one to two weeks after surgery.
- Have all prescriptions filled ahead of time
- If you have been asked to obtain a post-operative garment, please bring it with you on the day of surgery.
Important things to remember
- Many supplements and vitamins can affect blood clotting ability; or the effectiveness of anesthesia, so it is extremely important that you follow these guidelines
- A surgical site infection (SSI) is an infection that patients can get during or after surgery. They can happen on any part of the body where the surgery takes place and sometimes only involve superficial layers of the skin. Other SSIs are more serious – they can involve tissues under the skin, organs or implanted material.
Preparing for surgery with Hibiclens
Many hospitals and healthcare facilities specifically recommend bathing with Hibiclens. If you don’t receive definite instructions, here’s how to prepare for your surgery:
- If you plan to wash your hair, use your regular shampoo; then rinse your hair and body thoroughly to remove any shampoo residue
- Wash your face with your regular soap or water only
- Thoroughly rinse your body with water from the neck down
- Apply Hibiclens directly on your skin or on a wet washcloth and wash gently; move away from the shower stream when applying Hibiclens to avoid rinsing it off too soon
- Rinse thoroughly with warm water and keep out of eyes, ears and mouth; if Hibiclens comes in contact with these areas, rinse out promptly
- Dry your skin with a towel
- Do not use your regular soap after applying and rinsing with Hibiclens
- Do not apply lotions or deodorants to the cleaned body area
- You may be instructed to bathe multiple times with Hibiclens – be sure to follow Dr. Li’s orders!
Why is Hibiclens pink?
Hibiclens has been used in hospitals for many years as an antiseptic skin cleanser, and its color relates back to its acute care history. It is pink for identification purposes to prevent mistakes in the operating room.
GLP-1 Agonist Medications
Are you taking GLP-1 agonists (such as Ozempic, Wegovy, Mounjaro, or Zepbound) for diabetes or weight loss?
These medications slow down how quickly your stomach empties. Even with standard fasting, food or liquid may remain in your stomach, which increases the risk of vomiting or inhaling stomach contents during anesthesia. To keep you safe, you may need to pause your GLP-1 medication before surgery. Pausing the medication lets your stomach empty normally and keeps you safe during surgery.
These include: Ozempic, Wegovy, Mounjaro, Zepbound, Trulicity
- Oral or weekly injections
- For patients on daily dosing: hold GLP-1 agonists on the SAME day of procedure/surgery.
- For patients on weekly dosing: hold GLP-1 agonistsONE WEEK BEFORE the procedure/surgery date.
- This suggestion is irrespective of the indication ( type 2 diabetes mellitus or weight loss ), dose, or the type of procedure/surgery.
- If you take a GLP-1 medication for diabetes and need to stop it for longer than your normal dosing schedule, please check with your endocrinologist or primary doctor. They may give you a short-acting substitute to keep your blood sugars safely controlled while your GLP-1 medication is on hold.
Arnica
Arnica is a natural homeopathic supplement with anecdotal reports and some studies showing potential benefits for reducing bruising, swelling, and certain types of pain. In preparation for surgery we recommend starting oral Arnica 10 days before surgery and continue for 10 days after surgery. Depending on which brand you take, follow-up the package instructions. A common brand found in stores is Boiron Arnica. If you experience any side effects such as nausea/vomiting, or gastrointestinal upset, please stop immediately.
Steroids
Some patients may be prescribed short courses of corticosteroids for asthma, severe allergies, or other inflammatory conditions. Common examples include prednisone, methylprednisolone (Medrol), dexamethasone, and hydrocortisone. These medications are known to slow or impair wound healing, so it is essential that you inform Dr. Li and Traci Young, NP if you are taking them. If surgery cannot be postponed until you are off corticosteroids, Dr. Li may recommend taking oral Vitamin A (25,000–50,000 IU daily) to help support wound healing. You must have normal liver function to safely take higher-dose Vitamin A. No prescription is needed; these supplements can be purchased at any pharmacy or vitamin store.
SGLT Inhibitors: gliflozins
Current recommendations are to hold 3-4 days prior to surgery for elective surgery because of risk of DKA except Ertuglifozin which is 4 days.
| Generic | Brand | Hold days prior to surgery | Frequency | Route |
| Canagliflozin | Invokana | 3 | Daily | Oral |
| Dapagliflozin | Farxiga | 3 | Daily | Oral |
| Empagliflozin | Jardiance | 3 | Daily | Oral |
| Ertugliflozin | Steglatro | 3 | Daily | Oral |
| Empagliflozin/Metformin | Synjardy | 3 | Daily | Oral |
| Empagliflozin/Linagliptin/Metformin | Trijardy | 3 | Daily | Oral |
| Sotagliflozin | Inpefa | 3 | Daily | Oral |
| Farxiga/Metformin | Xigduo | 3 | Daily | Oral |
GLP-1 Receptor Agonists: “tide”
class of drugs that reduce blood sugar and energy intake by activating the GLP-1 receptor. They mimic the actions of the endogenous incretin hormone GLP-1 that is released by the gut after eating.
Current recommendations are to stop taking these medications 7-10 days before surgery if possible and to consider other alternatives in the meantime (except those noted above that are on daily dosing).
| Generic | Brand | Hold Days Prior to Surgery | Frequency | Route |
| Dulaglutide | Trulicity | 7-10 | Weekly | Injection |
| Exenatide ER | Bydureon | 7-10 | Weekly | Injection |
| Exenatide ER | Bcise | 7-10 | Weekly | Injection |
| Exenatide | Byetta | 7-10 | BID | Injection |
| Semaglutide | Ozempic | 7-10 | Weekly | Injection |
| Semaglutide | Rybelsus | 1-3 | Daily | Oral |
| Semaglutide | Wegovy | 7-10 | Weekly | Injection |
| Liraglutide | Victoza | 1-3 | Weekly | Injection |
| Liraglutide | Saxenda | 1-3 | Weekly | Injection |
| Lixisenatide | Adlyxin | 1-3 | Weekly | Injection |
| Tirzepatide | Mounjaro | 7-10 | Daily | Injection |
| Tirzepatide | Zepbound | 7-10 | Daily | Injection |
| Diabetes | |||
|---|---|---|---|
| Drug Class | Drugs in Class | Day Before Surgery | Day of Surgery |
| Insulin: rapid/short acting | Regular insulin (humulin, novolin, afrezza-inhaled)Aspart (novolog)Glulisine (apidra)Lispro (humalog) | continue | Hold |
| Insulin: intermediate acting mixes | Asapart promatime/aspart (novolog 70/30)Lispro protamine/lispro (humalog 75/25, 50/50)NPH/regular (humulin/novolin 70/30) | 80% of usual dose AM & PM | 50% of usual dose if 8g<120 Hold if BG = 120 |
| Insulin: long acting | Degludec (tresiba)Detemir (levimir)Glargine (Abasaglar, basaglar, lantus, toujeo) | 80% of usual dose if taken in PM | 80% of usual dose if taken in AM |
| Insulin: pumps | Decrease basal rate at bedtime by 20% | Continue at 20% reduced basal rate | |
| Oral Hypoglycemic alpha-glucosidase inhibition | Acarbose (precose)Miglitol (glyset) | Continue | Hold |
| Oral Hypoglycemic biguanides | Metformin (Glucophage)Saxagliptin/Metformin ER (Kombiglyze XR) Sitagliptin/Metformin ER (Janumet) | Continue | Hold |
| Oral Hypoglycemic DPP-4 inhibitors | Alogliptin (Nesina) Linagliptin (Tradjenta) Saxagliptin (Onglyza) Sitagliptin (Januvia) | Continue | Continue |
| Oral Hypoglycemic sulfonylureas & meglitinides | Repaglinide (Prandin)Nateglinide (Starlix)Acetohexamide (Dymelor) Chlorpropamide (Diabinese) Glimepiride (Amaryl) Glipizide (Glucotro!) Glipizide/Metformin (Metaglip) Glyburide (Micronase, Diabeta) Glyburide/Metformin (Glucovance) Tolazamide (Tolinase) Tolbutamide (Orinase) | Hold PM prior to DOS: Long acting sulfonylureas (Chlorpropamide, Glimepiride, Glyburide, Glipizide XR) | Hold |
| Oral Hypoglycemic Thiazolidinediones | Rosiglitazone (Avandia) Pioglitazone (Actos) Alogliptin/Pioglitazone (Oseni) | Continue | Hold |
| Oral Hypoglycemic SGLT-2 inhibitors | Canagliflozin (Invakana) Dapagliflozin (Farxgia) Empagliflozin (Jardiance) Ertugliflozin (Steglatro) *** Empagliflozin & Metformin (Synjardy, Synjardy XR} | Hold 3 days prior to DOS*** if ertuglifozin/steglatro, hold 4 days | Hold 3-4 days prior to DOSPossible hypoglycemia, lactic acidosis |
| Glucagon-like peptide (GLP)-1 receptor agonists: injection and oral | Albiglutide (Tandem) Dulaglutide (Trulicity)Exenatide (Byetta, Bydureon) Liraglutide (Victoza, Saxenda, Tradjenta-oral) Lixisenatide (Adlyxin) Pramlintide (Symlin) Semaglutide (Ozempic, Wegovy, Rybelsus-oral) Tirzepatide (Mounjaro, Zepbound) | Daily dosage: hold DOS Weekly dosage: hold 1 week prior to DOS Risk of gastric emptying delay | Hold |