How to Prepare for Orthopaedic Foot or Ankle Surgery: Part II

​Part II: The Day of Your Surgery

 
Patients with orthopaedic foot or ankle conditions that need surgery are unique in their needs and considerations. This is because they have a wide variety of conditions, which need different types of combined medical and surgical treatment.  Despite these differences, preparation and education about what to expect from surgery aids in doing well afterwards. 
 
This is a guide for patients to participate in their foot and ankle surgical treatment. Patients achieve the best results when they work with their surgeon to prepare for their surgery and post-surgical recovery. Part II will focus on what to do the day of your surgery.
 

When do patients have to arrive at the hospital or surgical center on the day of surgery?


A physician, nurse or administrator will usually call patients the day before their surgery. Please note that if a patient’s day of surgery is on a Monday, the pre-surgical phone call will likely be on the previous Friday. If patients have not received their pre-surgical phone by the end of the workday, they should contact their surgeon.

The purpose of this pre-surgical phone call is to inform patients specifically when and where they must appear on the day of surgery. While each hospital or surgical center has different policies, most will ask patients to come in one to a few hours before their scheduled time of surgery. Much of this time is spent preparing patients for surgery. Things done to get patients ready for surgery include registration, getting changed, storing belongings, receiving an intravenous (IV)  line placed in an arm vein to receive fluids, and a thorough examination from an anesthesiologist.
 

What should patients bring with them on the day of surgery?


While each center has different policies, it is highly recommended that all patients bring with them on their day of surgery:
·         Medical insurance card
·         Passport or driver’s license as legal identification
·         List of medications that are regularly taken
·         Immunization record if patient is a minor
·         Credit card and small amount of cash
·         Copy of pre-surgical test results. This is very important to have if these tests were done at a location different   from the place of surgery.
·         Assistive devices, such as crutches or a walker, to be used after surgery
·         Small bag for personal belongings
 
While each hospital or surgical center may have different policies, it is not recommended for patients to bring jewelry (including rings and piercings), large amounts of cash and more than one credit card on the day of surgery. Small items like these can be misplaced at a busy hospital or surgical center.
 

What should patients wear on the day of surgery?


On the day of surgery, patients should wear loose, comfortable clothing. Patients will have a bulky dressing and/or plaster splint on their operated leg, ankle, and/or foot after surgery, so their clothes must fit around their dressing and/or splint.  Examples of such clothes include shorts or sweat pants without elastic bottoms.

Due to their post-surgical dressing and/or splint, patients cannot wear normal shoes on their operated foot until it is healed. This means that patients should bring a supportive non-slip shoe with rubber soles to wear on their non-surgical foot. 
Just before surgery, patients will be asked to change into a hospital gown. Depending on the policies of the hospital or surgical center, patients may be asked to remove their underwear while wearing the hospital gown. Patients will continue to wear their hospital gown until they leave the hospital or surgical center. If patients stay in the hospital after surgery, it is recommended that they bring a short robe to wear over their hospital gown.
 

Who will patients meet with on the day of surgery?


Once patients are dressed in their gown, they will meet with a pre-surgical nurse or physician’s assistant (PA). They may review notes and tests, shave and cleanse the part of the body to receive surgery, and perform a physical exam on the patient. They will also place an IV in one of the patient’s arms. This IV allows patients to receive fluids and/or medicines without eating or drinking.

After the IV is placed, patients will meet with the surgical team. This team includes the surgeon, surgical nurses, PAs and possibly assisting surgeons in training. Such assisting surgeons are common at university or academic hospitals and are known as orthopaedic surgical residents and fellows. While patients will meet with many people that are important parts of the surgical team, it is important to recognize that the orthopaedic foot/ankle surgeon is the leader of the team that will be performing the actual surgery. Nurses, PAs and assisting surgeons help the surgeon during surgery.

As the leader of the team, the orthopaedic foot and ankle surgeon will speak again with the patient about details of surgery. Many surgeons will have already discussed what to expect from surgery with the patient, but this lets patients express any last-minute questions or concerns they may have to the surgeon. At this time, the surgeon will mark the patient’s surgical area with his/her initials via pen or marker. This interaction between the surgeon and patient is a complete reminder to both people as to what type of surgery will be done appropriately. To ensure the entire team is aware of the plan, other members of the surgical team will check that the correct area on the patient has been marked for surgery.

After the patient has met with the surgical team, he or she will meet with the anesthesia team just before having surgery. This team includes the anesthesiologist who will make sure that the patient feels neither pain nor discomfort during surgery, nurse anesthetists (CRNAs) and possibly assisting anesthesiologists in training. Such assisting doctors are common at university or academic hospitals and are known as resident anesthesiologists. While patients will meet with many people that are a part of the anesthesia team, it is important to recognize that the anesthesiologist is the leader of the team that will be performing the actual anesthesia.  Nurses and residents provide whatever help the anesthesiologist may need during anesthesia and are an important part of the team providing patient care.
 

What are the options for anesthesia during surgery?


Anesthesia is a condition where patients experience no pain and limited memory from a situation. Some form of anesthesia is needed for patients to safely receive any kind of foot or ankle surgery.
One way that patients can receive anesthesia during surgery is through general anesthesia. With general anesthesia, patients are completely asleep during surgery. Patients receive medicine through their IV to make them fall asleep. Once asleep, patients are paralyzed and receive a tube in their mouth (laryngeal mask airway or LMA) or their windpipe (endotracheal tube or ETT) to keep them breathing during surgery.
 
Another way that patients can receive anesthesia during surgery is through regional anesthesia. This type of anesthesia provides numbness only to the leg, ankle or foot that will be operated upon without needing the patient to be paralyzed, asleep, or have a breathing device in their airway. Some examples of regional anesthesia include spinals or epidurals where numbing medicine is injected into the back and spinal cord, near the spinal nerves.

Another example of regional anesthesia is a nerve block where numbing medicine is injected into the thigh or leg, near large nerves above the foot and ankle to receive surgery. Whether the numbing medicine is given in the back, thigh or leg, the regional anesthesia works by affecting large nerves above the involved foot and ankle. One advantage that such regional anesthesia has over general anesthesia is that patients can have pain relief many hours after surgery when the nerves above the operated foot and ankle are left numb. Other advantages that regional anesthesia has is that most patients do not experience nausea, vomiting and a sore throat which are more common after general anesthesia.
 

How long will patients have to stay in the hospital after surgery?

  
Patients that receive inpatient surgery will stay in the hospital for one or two nights after surgery. This is usually done for surgeries that are very complex, where patients may have more pain and/or discomfort than with less complex foot and ankle surgeries. Patients may also need to stay in the hospital after surgery if they have certain medical conditions that need to be checked on after surgery.
 
Patients that receive ambulatory or outpatient surgery will have their surgery and then go home after becoming fully awake in a recovery room after surgery.The amount of time from surgery to being fully awake is always different for a variety of patients and surgeries, but is typically between three and six hours.While each hospital or surgical center may have different policies for when a patient is ready to go home after surgery, patients should be able to:

·         Safely stand and walk independently without feeling dizzy or lightheaded, losing balance and falling.
·         Urinate without problems.
·         Eat and/or drink small amounts without nausea or vomiting.

 

Where will family members wait or stay during a patient’s surgery?


While each hospital or surgical center may have different policies for where a patient’s family can wait or stay during a patient’s surgery, all medical staff will provide as much comfort for family members at this time. Some hospitals and surgical centers will allow family to stay with the patient in the pre-surgical area until the patient is delivered to the surgical area. Many hospitals and surgical centers have an assigned waiting room where family members can stay while patients receive surgery.

After a patient’s surgery is done, some hospitals and surgical centers will allow family to briefly visit the patient in the post-surgical recovery room. Many hospitals and surgical centers have an assigned post-surgical discharge area where family can be formally reunited with the patient, as he/she is more awake and ready to go home. If patients are to be admitted to the hospital after surgery, family members may have to wait for the patient to be brought to his/her hospital room before they can be formally reunited with him/her.

Part I: Before Day of Surgery
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find an Orthopaedic Foot & Ankle Surgeon" tool at the top of this page or contact your primary doctor.