Pre-Op Class

MBSAQIPMetabolic and Bariatric Surgery Accreditation and Quality Improvement Program

• Our center is proud to be accredited through MBSAQIP. • MBSAQIP compares SSM WMS to others in our market

• We report all types of surgeries, surgical outcomes, complications and readmissions.

• Required to maintain that standard.

What is Enhanced Recovery• A care pathway that is designed to decrease

1. Nausea 2. Pain 3. Stress after surgery4. Swelling 5. Reduce the amount of narcotic pain medicine required (opioids)6. Complications

• A quicker recovery and return to normal activities

Enhanced Recovery Medications

• Local Anesthetic - Injected to numb nerves going to your incisions. This is injected during surgery

and the effect lasts about 3 days.

• Narcotics – You will be offered the opioid, Lortab, postop. Remember that opioids have many

negative side effects.

• Nausea, decreased bowel activity, & drowsiness

• Anti-Nausea Medications – It is easier to prevent than treat nausea. Patch or IV

• While on the medical floor you will be given IV antiemetrics routinely. If this does not help please notify your nurse

so that she may speak with the surgeon for further treatment.

Start Preparing Weeks Prior to Surgery

• Don’t gain weight.

• Surgeries can be cancelled due to weight gain.

• Follow your diet

• Stay active

• Get plenty of sleep

• CPAP - wear as directed to insure adequate quality sleep

Please Stop ALL OTC BLOOD THINNERS 5-7 Days Before Surgery to Prevent Bleeding

• Blood Thinners• Aspirin (Except for prescribed 81mg dose)• Ibuprofen• Advil• Motrin• Aleve• Vitamin E• Flaxseed Oil• Fish Oil• Omega 3

Night Before Surgery• Drink your clear liquids – Water, Decaf tea or coffee (no cream), broth• Drink 24oz of Carbohydrate drink

• 100% Apple Juice• 100% Cranberry Juice• 100% Pulp free orange juice• 100% Grape Juice• Stay away from Cocktail Juice.• Gatorade (Original)

• Clean skin with cleanser as instructed by Surgery Evaluation Center.• Don’t Forget your Belly Button

• Do not shave surgical area.

Morning of Surgery• Take medications as instructed by Surgical Evaluation Center

• Clean your skin with cleaner as instructed by Surgical Evaluation Center

• Drink 24 oz of a carbohydrate drink

• Have the drink consumed 2 hours before you arrive at the hospital

• 4 hours prior to your surgery

• Dress in comfortable clothes and shoes – nothing tight around the waist

Morning of Surgery• Park in either Lot 1 or 2. Enter through the East lobby Entrance

• Go to 2nd floor of the South Medical Bldg. Check in at the Outpatient

Surgery waiting room.

• Use Restroom-only after checking with nursing staff

What to bring• Items needed :

• Photo ID, • Health insurance card, • Current list of medications including herbals and supplements.

• You can bring a pillow, don’t use a white pillow case.

• Please bring your C-Pap for use after surgery in your room.

What to leave at Home

• Remove all jewelry and anything else that is removable

• Leave valuables at home

• Medication from home

Surgery• Length of Surgery

• Band = 30-60 minutes• Sleeve = 60-90 minutes• RYGB = 60-90 minutes• Revisions = 1-3 hours• DS = 60-90 minutes

* Typically a 1-2 night stay for Sleeve, RYGB and DS

Recovery• Typically spend 1-3 hours in the recovery room• 3 goals of recovery room

1. Wake up from anesthesia2. Get pain management underway3. Nausea management underway

There will NOT be any drains or tubes after surgery.

Night of Surgery • You will be admitted to either 6 South or 3 North, staff have

specialized training for Bariatric patients.

• Nausea – If nauseated, tell your Nurse

• Pain - You will be offered p.o. Liquid Lortab or Tylenol for pain control

every 4 hours.

• Deferred gas pain to shoulder

Night of Surgery• Get out of bed and walk – you will be allowed to wear your own clothes to

walk in the halls. • decrease risk of blood clots• Increase lung capacity• Help eliminate abdominal gas• Help your bowels to return to normal.

• Sip fluids and save cups for fluid calculations. Staff will track the amount of fluid in and amount of fluids out.

• Wear compression sleeves when you’re in bed• Morning After Surgery

• Swallow Study- In Radiology, do not drink after 6am, then continue drinks after test.

Discharge from the Hospital• Increased fluid intake

• Tolerating protein and 4-6oz liquid/ hour

• Pain and nausea under control

• Purchase your Lortab at the Pharmacy prior to leaving

• If your ride home is one hour or more drive – You should stop and

walk for 10 minutes for each hour of driving to prevent blood clots

Pharmacy At Home Medications

• Prilosec- 6 Months• Lortab- As Needed for Immediate Post-Op Pain Control (Short Term)• Tylenol- Long Term Pain Control• No NSAIDS for Life

Additional Information• Stop All Steroid use

• At least 2 weeks prior and 4 weeks after surgery

• No Alcohol for a year• Stop Smoking for life

• Can cause ulcers

• No NSAIDS • No Estrogen based hormonal birth control for 2 week prior till 4

weeks after surgery.

For the first 4 weeks after surgery do not swallow any pills larger than the

size of a regular Aspirin.

At Home• MUST

• Ambulate frequently (at least 4-5 times per day)

• Continue walking regularly and increase duration and intensity as tolerated.

• Use incentive spirometer

• 10 deep breaths in a row every hour, continue for 10 days

• Leave incisions open to air

• NO Band-Aids and do not pick at incision glue

• Shower daily preferably with an antibacterial soap (Dial)

• Pain and Nausea – Take prescriptions given as needed. Use ice pack on sore areas. Ask for an abdominal binder

• If pain or nausea persist, please contact us.

• Advance diet ONLY upon Providers recommendation.

• No baths, hot tub, soaking or swimming for 4 weeks (until the incisions are completely healed)

• No Blind Nasogastric Tube Insertion

Recommendations for…

• GAS:• Gas pain is relieved by walking• You may also use GAS-X; the dissolvable strips are available and easy to use

• CONSTIPATION• Constipation is prevented by walking and adequate fluid intake. • You may use a stool softener 1-2x per day.• For irregular bowl movements try Benefiber powder.• Miralax or Milk of Magnesia can be used daily as needed.• If you have no results in 2-3 days: use a suppository.• Contact us if problem persists.

When to Call the Office• VOMITING (IS NOT NORMAL)• Nausea• Pain uncontrolled with medication• Fever over 101 degrees Fahrenheit• Shortness of Breath• Very Fast heart rate• Bleeding• Incision redness, drainage, warm to touch• Use MY CHART ™ for NON URGENT Questions, if you

are not signed up for My Chart, please do so today. • Whenever you have a question!

• Food, Pain, Medications, Fluids, Activity…

• This a case by case basis decision. It will depend on the level of work activity

you have and in particular the amount of bending or lifting in your job.

• Please discuss specific work limitations with your N.P. at your 1 week

follow-up.

• Most of you will be released back to work at your 4 week visit.

• Once released, it is typically the expectation of your work that you return on

the next business day.

Follow-up Visits• It is Imperative that you keep your ALL appointment. We need to monitor your health.

• Please arrive 15 minutes early for all appointments.

• You will be seen at 1-week, 1-month, 6-months, and 1-year.

• DS Patients: 1-week, 1-month, 3-months, 9-months, 1-year

• We will then need to see you EVERY YEAR after.

• 1 month follow-up

• Sleeve Patients: will be in this Classroom. Please let us know before class, if you need a return to work note.

• All Others: Will be seen by appointment.

Possible Early Complications• Staple or suture leaks

• Intra-abdominal bleeding

• Respiratory distress

• Blood clots

Possible Late Complications• Cholecystitis (gallbladder)

• Incisional Hernia

• Vitamin Deficiency

• Peptic Ulcers

Press Ganey SurveyAfter your discharge from the hospital you may receive a survey about

your carePlease fill that out and give 6 South the top score!

Summary• Get body ready for surgical stress• No weight gain

• Drink 24 oz. Carbohydrates night before and morning of surgery• Walk frequently• Sips fluids & gradually increase fluid intake

• Take Prilosec and other Rx as recommended • Wear compression sleeves and use incentive spirometer• Call or MyChart with questions or concerns

Congratulationsand Rapid Recovery