Frequently Asked Questions about Surgery

Surgery is a medical specialty that includes operations and procedures performed by specially trained doctors and surgical teams to treat an illness or repair an injured part of your body. Surgeons use different techniques or ways of gaining access to the injured or diseased area in order to repair it. Some common surgical procedures are outlined in the ACS Patient Education brochures. 

Find them here.

When your surgeon is board certified it means that she or he has completed additional, voluntary training and testing beyond obtaining a medical license and completing a residency (five years for general surgery). Board certification is an extra step that many doctors take to demonstrate that they know the latest advancements in their specialty. When your surgeon is board certified, it means that he or she has completed additional voluntary training and testing in their area of medical expertise. They continue this training throughout their careers. You can check if your physician is certified on the American Board of Medical Specialties (ABMS) website. https://www.certificationmatters.org/find-my-doctor/ 

To be a Fellow of the American College of Surgeons, surgeons have a medical license and are board certified. Additionally, they must have a current appointment at a hospital and have no reportable actions pending. They must also seek the support of and letters of reference from two Fellows from the College as well as the chief of surgical services at their primary hospital. Fellows must also submit a listing of all the surgical procedures they have performed in the past year. Sometimes they may be requested to present detailed case reports as evidence of their professional competence. Ultimately, Fellows are held to high codes of conduct and ethics and are deemed professionally competent. Many times, a surgeon will have multiple credentials.

References:

• ABS. Your surgeon is certified by The American Board of Surgery. Available at https://www.absurgery.org/xfer/YourSurgeonIsCertified.pdf Accessed June, 2023.
• AMBS Certification Matters. Available at: https://www.certificationmatters.org/find-my-doctor/ Accessed Aug, 2023
• ACS. Fellowship requirements. Available at https://www.facs.org/for-medical- professionals/membership-community/membership- benefits/fellows/fellowship- requirements/#:~:text=United%20States%20and%20Canada,ethical%20standard s%20of%20the%20College. Accessed June, 2023.

The time before your surgery. This can include preoperative doctor visits, labs, or additional tests.

The time you spend in surgery. This includes the time you are in the operating room, before you are moved to the PACU/recovery area.

The time after your surgery. This includes recovery time in the post-anesthesia care unit (PACU) and/or on the hospital floor and at home.

The time you spend in the post-anesthesia care unit (PACU). While in recovery, the team will monitor your oxygen levels, blood pressure, and other vital signs. During surgery, you may have received a medication that makes you sleepy(anesthesia). The team in the PACU will monitor you as you wake up, including assessing how alert/awake you are and how much discomfort you are in. After being monitored in the PACU, you will be transferred to a hospital unit or home, if you are having an outpatient/ “same day” surgery.

Leaving the hospital. Your surgical team and care providers will discuss what you must do in order to be discharged from the hospital. Depending on your health and needs when you leave the hospital, you may be discharged to your home or a skilled nursing facility (SNF), or you may have additional services ordered for you, such as home health nursing or physical therapy.

A fellowship is additional training a doctor completes after medical school and surgical residency. (A surgical residency is clinical time spent as a practicing surgeon, under supervision of established (attending) surgeons.) Fellowships provide surgeons with more focused training in a specific surgical specialty.

Reference: Post-Residency Fellowships | ACS (facs.org)

A general surgeon is a specialist who is trained to manage a broad spectrum of surgical conditions affecting almost any area of the body. The surgeon establishes the diagnosis and provides the preoperative, operative, and post-operative care to patients and is often responsible for the comprehensive management of the trauma victim and the critically ill patient. Read about more Surgical Specialties.

Surgical care includes caring for patients in the pre-, intra-, and postoperative timeframes. Preoperative care includes assessment, diagnosis, and educating patients about options – including any surgical and non-surgical options, along with risks and benefits. Surgical care also includes obtaining informed consent for any procedure(s), performing the procedure, and monitoring the patient in the postoperative timeframe. Postoperative interventions may also be included in surgical care, such as removal of sutures or staples.

Surgery costs vary greatly, depending on the procedure and where it is performed. Many variables affect the cost of surgery. Some of these include: physician and other specialists fees, pathology (lab) fees, medications, instrument/equipment use, and a fee for the hospital room.

The cost of the operation depends on your insurance coverage and if the doctors and hospital providing your care are in your insurance network. Your insurance carrier often can provide you with information on the average cost of the procedure that you will need.

Some insurance companies and/or hospitals/surgery centers have cost estimator tools to help patients determine an estimate for their surgical bill.

The hospital/surgical billing department can also provide an estimate. However, the actual cost may not match the estimated amount, especially if there are unexpected findings during your surgery or a prolonged hospital stay that was not planned. If you have Medicare, use the link here (Procedure Price Lookup for Outpatient Services | Medicare.gov) to see a cost estimate of your procedure. Keep in mind, this may not be the final price you pay out of pocket, as the prices shown are national averages.

Some procedures and insurance companies may require a “prior authorization” before surgery. Your surgeon’s office or the hospital may get the authorization for you. Call your insurance carrier, notify them of the procedure you will be having, and ask if you will need a prior authorization. If you do, be sure to have the authorization letter in-hand before the day of surgery.

Call your insurance provider to determine if your procedure will be considered “in- network” or “out of network”. Patients pay less money out of pocket for “in-network” treatment. In 2022, a new law went into effect, called the No Surprises Act. Under this law, if you go to receive care at a hospital that is in-network with your insurance, you will not be charged extra for an out-of-network provider who cares for you at the in- network facility.

• Ending Surprise Medical Bills | CMS

After your procedure, you will receive a statement (not a bill) from your insurance provider, noting the total cost that was billed, what insurance covered, and what you may owe. If you owe money, you will also receive bills for your care. You may receive multiple bills from different providers, labs, or facility locations. Be sure to call the hospital’s billing department if you have any questions about bills you receive or payments due. You may also wish to ask about payment plan options if you have a large balance.

• Your surgeon can give you a window of time for how long the surgery will last. This time is an estimate, as many factors impact the length of your surgery. Factors impacting length of surgery include your overall health, if the surgery is routine or complex, the presence of complications, or if the surgeon has to change approaches (from minimally invasive to an open surgery), etc.
• Your procedure will be scheduled for a specific time on a specific day. Before the surgery date you may receive a call from the hospital or center. They will tell you the time to arrive, and how to prepare for your surgery (any fasting or special eating / drinking instructions, as well any other instructions on how to prep the surgical site the night before). The actual time that your procedure begins may be earlier or later than the initial scheduled time, depending on all the other procedures that are scheduled that day.
• You will need to arrive early at the surgery center or hospital to check-in and be prepped for surgery (examples: changed into a gown, scrubbed, meet with your anesthesiologist, ID bracelet). Have your ID and insurance card with you and/or the person who will be driving you. Your healthcare team will review your health history, medications, give you an opportunity to ask questions, mark the surgical site, and give you an ID band around your wrist. After surgery, you will likely be moved to a recovery area such as a post anesthesia care unit before being discharged for same day surgery or moved to another hospital unit.
• Reference: Medline Plus. The day of your surgery-adult.  Accessed June, 2023.

Your wait time for surgery depends on the complexity of your disease and your overall health. For procedures that that are not urgent, such as hernia repair, the surgeon, your anesthesiologist, and your family physician will determine whether pre-procedure laboratory studies should be obtained. If you are diabetic or on anti-coagulants (blood thinners), you may also have additional laboratory testing prior to surgery.

For cancer-related procedures, additional testing including imaging is often done before your procedure.

Other factors include: surgeon’s availability, elective vs. urgent (priority may go to emergencies), busy hospital, site-specific (small hospital vs large medical center), authorization from insurance company, testing.

When you meet with the surgeon, they will talk with you about the need for an operation and the procedure that is effective in treating your health problem. She/he will discuss the outcome(s) you should anticipate and the alternatives, including non-surgery options. (American College of Surgeons Statement on Principles).

For some operations, there are different approaches to the procedure. For example, a procedure can be done using an open technique or a minimally invasive technique. Minimally invasive methods use a scope and instruments inserted to the inside of your body through very small surgical incisions. This can be done laparoscopically or robotically. There are times when your surgeon may start your operation using a minimally invasive approach but will have to convert to an open approach. (American College of Surgeons 2023).

Your surgeon and medical team will talk with you about other options besides surgery that may help treat your health problem. The goal is to treat the disease, decrease the pain and improve your overall health. For example, treatment for bone and joint injuries could be done first with locally administered medication to treat the pain and allow the body time to heal (American Academy of Orthopedic Surgeons).

For certain tumors, treatment such as chemotherapy, radiation, or immunotherapy may be recommended before an operation to decrease the size of the tumor. ASCO Answers Fact Sheets | Cancer.Net

Your surgeon will inform you of the benefits that you should see from the operation and the risks/complications that can happen with your procedure. The risks and complications are different depending on your current health and other medications/drugs you are taking. For example, if you smoke you increase your risks of infection – both in your lungs and at your wound site. The surgeon can use a risk calculator that includes your health conditions that could affect the outcomes and complications you will have. You can also access the ACS risk calculator. 

Your surgeon may schedule tests that you need to either confirm your diagnosis or check your overall health status so that you have the best possible recovery. recovery. Blood work, scans and an Electrocardiogram (EKG) if you are over age 50 or high risk are some of the tests obtained.

Your surgeon will schedule tests that you need to either confirm your diagnosis or check your overall health status so that you will have the best possible recovery. Blood work, scans, and an Electrocardiogram (EKG) if you are over age 50 or high risk are some examples of the tests obtained.

Before surgery, your medications will be reviewed by your anesthesiologist and your surgeon. They will let you know of any changes in the medications and vitamins you are taking. You usually take your morning medications with a sip of water. Since you are not eating before surgery, most diabetic medication is adjusted or reduced the morning of surgery. Blood thinning medication, including many herbs and pain control medications such as aspirin and ibuprofen may be stopped prior to your operation. This depends on the length and type of operation you are having. Alcohol, cannabis, marijuana, and medications used for anxiety and sleep can affect your heart rate, blood pressure and pain control during and after your procedure. See Medication and Surgery: Before Your Operation | ACS (facs.org)

The night before and/or the morning of your surgery, you should shower/wash with antimicrobial soap. You may also be given a special soap to use. Use a clean towel to dry your skin and put on clean loose clothes. Before surgery, do not shave, clip or wax any body hair at the area of your surgery. The morning of surgery, rinse your mouth with antimicrobial mouthwash.

You will receive instructions from your surgeon and surgical team about not eating and drinking on the day of surgery. For some operations, your surgeon may order a bowel prep, and you may have to not eat for a longer period of time and drink clear liquids and carbohydrate rich drinks on a specific schedule.

Anesthesia is medication that eliminates the pain during your procedure. Your surgeon and anesthesia provider will talk to you about your options. There are 4 main types of anesthesia.

General anesthesia is a combination of medication that results in you being totally unconscious and not responsive to painful stimuli. This is used mainly for major operations. Your breathing is managed through a ventilator and your heart rate and blood pressure are closely monitored. Regional or local anesthesia is the elimination of sensation, especially pain, in one area of the body. This can be done with medication given topically on the skin, injected around/near the pain site or given regionally as a nerve block which affects an entire section of the body. The part of the body may have no sensation or feeling for hours and sometimes up to several days. This can decrease the need for other pain medications.

Sedation is medication that is given through an IV that results in a depressed level of awareness – so you are sleepy and you do not feel pain, The level of sedation can range from minimal (where you are still able to breathe on your own and can respond to commands) to deep sedation (where you are sleeping and do not respond except to strong pain and you may need some supplemental oxygen). Your heart rate, breathing and blood pressure are closely monitored during sedation.

Spinal and epidural anesthesia involves medication placed near the nerves by the spinal cord. Spinal anesthesia is given as a single injection. Epidural anesthesia can be given through a small tube left in a precise location near the spinal nerves. The tubing is left in place so medication can be given continuously. (American Association of Hospital Anesthesiologists).

For activity, you should be up and moving doing activities of daily living and walking around your home. Lifting may be limited, often to no more than a gallon of milk. You will routinely return to your home medications that you were taking before surgery.

Other medications related to your operation may include:

• Pain medication
• Stool softener
• Blood thinner (If you are at a high risk of getting a blood clot and possibly an antibiotic).

Often, just a single dose of an antibiotic is given in the hospital and then no longer needed when you are at home. Most often, you return to a healthy diet, and on occasion you may have to start with soft foods.

Your surgeon may give you an order form for autologous (donated for your own use) donation. You usually do this several weeks before your operation and you have to be in good health, not be anemic and with no active infections. Many surgeons prefer that you do not donate blood within 7 days of your operation. See Redcross.org for more information.

Your medications will be reviewed, and you usually take your morning medications with a sip of water. Since you are not eating before surgery, most diabetic medication is adjusted or reduced the morning of surgery. This may be a little different depending on your age and type of surgery. Blood thinning medication, including many herbs and pain control medications such as aspirin and ibuprofen may be stopped prior to your operation. This depends on the length and type of operation you are having. Alcohol, Cannabis, marijuana, and medications used for anxiety and sleep can affect your heart rate, blood pressure and pain control during and after your procedure. Medication and Surgery: Before Your Operation | ACS (facs.org) Weight loss medications can slow your stomach emptying.

In preparation for surgery, do not eat for 4 hours or drink anything but clear liquids for at least 2 hours before surgery. For some operations, your surgeon may order a bowel prep, and you may have to not eat and longer periods of time and drink clear liquids and carbohydrate rich drinks on a specific schedule. Follow the specific instructions provided by your surgeon and surgical team.

The night before and/or the morning of your surgery, you should shower/wash with antimicrobial soap, such as Dial. You may also be given a special soap to use. Use a clean towel to dry your skin and put on clean loose clothes. Before surgery, do not shave, clip or wax any body hair at the area of your surgery. The morning of surgery, rinse your mouth with antimicrobial mouthwash.