Surgical Services

Before surgery, your surgeon may ask you to see your primary care provider for an examination and possibly tests. A surgeon may request this to make sure that surgery is not too hard on you. Your primary care provider may order certain tests such as blood tests, urine tests, and blood clotting tests to help determine your overall health.  You also may be scheduled for other tests, such as, X-rays or an electrocardiogram (EKG).

You will also have an appointment with your surgeon before your surgery. For this appointment, take along a list of surgery questions to help you understand your treatment. Your surgeon will explain why your surgery is needed, what it will involve, what the risks are and the expected outcome. The expected length of recovery will also be discussed. You may want to discuss other treatments that are available other than surgery.

Get as healthy as you can before surgery

• Talk to your family doctor or surgeon about things that you can do to improve your health before surgery. 
• As a general rule, the healthier you are before surgery, the faster you’ll be to recover and get back to normal. 
• If you smoke or drink heavily or use street drugs tell your family doctor or surgeon. These habits raise your risk of serious problems during and after surgery, and will make it harder for you to recover.

Stopping smoking before surgery

• Reduces the risk of complications
• Lowers the change of surgical site infections
• Shortens hospital stay

Get your free nicotine patches or nicotine gum through the BC Smoking Cessation program by visiting HealthLinkBC or calling 811.

Visit Quitnow.ca to learn more, and access resources about stopping smoking before surgery.

• Shower the morning of surgery, but do not use perfumes, colognes, or body lotion.
• You may be asked to do further skin preparation by your surgeon or the hospital. Be sure to follow those instructions.
• Remove all nail polish and body jewelry, such as piercings.
• Do not wear make up.
• Brush your teeth. Do not swallow.

Fasting restrictions

Restricting food and fluid (fasting) before surgery helps to keep the stomach empty during surgery.

Be sure to follow the instructions that are provided by your surgeon or preadmission clinic as to when you are to stop eating and drinking. Your surgery will be postponed if you do not follow the fasting instructions.

• Fasting before surgery: Adults
• Fasting before surgery: Children/infants

Stopping medications

Do not take any medications, prescription or non-prescription, on the day of your surgery without your physician’s specific permission. If you take heart or blood pressure medications, you will be instructed which medications to take with a sip of water on the morning of surgery.

What to bring to the hospital

Please be aware that you will be responsible for the care and safety of your personal property while you are at the hospital.

Documentation:

• Bring your BC Care card or proof of substitute Medical Insurance Plan.
• Identification showing your name, address and date of birth.
• Extended health care information.

Personal:

• Glasses or contact lenses, hearing aids, and dentures with storage cases labeled with your name.
• Bring your CPAP, Bi-level machines or dental appliance if you use one for sleep apnea.
• Any crutches, cane, braces or walker that you have been told by your surgeon to that you will need, labeled with your name, and brought in by family/friend after your surgery.
• If you are staying overnight or longer, pack a small bag with a few personal hygiene items such as toothpaste/toothbrush, lip moisturizer, brush/comb, shampoo, sanitary products, shaving kit.
• You will also bring any prescription medications, respiratory inhalers, eye drops, topical medicated creams, estrogen patches, or birth control pills (all other medications and supplements should be left at home). Most other medications are supplied by the hospital.
• Slippers with non-slip soles. Socks and comfortable shoes with rubber, non-skid, soles ( such as running shoes).
• Cell phone.
• A small amount of cash ($20- $40) to cover the cost of the TV rental, newspapers, coffee shop, etc.
• A novel or puzzle book.

Please do NOT bring

• All jewelry or body piercing items. (These items cannot be worn in the operating room because they increase your risk of infection and injury to the body)
• Laptops, DVD players, electronic games.
• Hair dryers.

Perioperative area

Once you have checked in and it is time for you to prepare for surgery, your nurse will:

• Check your name, your birth date and your signed consent for surgery. Your nurse will also check the correct body area for your surgery.
• Measure your vital signs (temperature, blood pressure, heart rate and respiratory rate and oxygen level).
• Measure your height and weight.
• Make sure you have not had anything to eat or drink for the length of time your surgeon or anesthesiologist told you.
• Ask you to change into a hospital gown.
• May give you some medicines ordered by your anesthesiologist.
• May start an intravenous (IV) in your arm or hand, if ordered by the surgeon or anesthesiologist, for fluids and medicines before, during and after your surgery.
• Give you antibiotics, if ordered by your surgeon.
• Ask your support person for a phone number where they can be reached when you are ready to go home or moved to a hospital room. If they wish to wait, they will be directed to a waiting area. Make sure this person can be contacted by phone at any time during the day of your surgery.
• If you do not arrange a person to escort you home or someone to stay with you for 24 hours after surgery, your surgery may be postponed until you can make these arrangements.

One family member or friend can stay with you until you are taken to the operating room.

Before going into the operating room, you will be asked to:

• Empty your bladder
• Remove your any dental work, dentures or plates, hearing aids, contact lenses, glasses and body piercings.

You may be moved to the operating room “holding area.” You will be asked questions you may have already answered. This is to double check all of your information. Your surgeon or anesthesiologist may visit you there.

When you are taken to the operating room, a nurse will greet you and check your hospital identification bracelet. You will be asked again about allergies and the type of surgery you are scheduled for. The nurse will stay with you to explain what is happening, answer any questions and offer support.

All of the staff members in the operating room wear special clothing, caps and masks. The operating room has bright lights and is quite cool. The special equipment, supplies and instruments have already been prepared by the surgery staff members.

The length of surgery depends on the type of surgery.

During surgery, your vital signs will be watched closely. Patches containing leads for monitoring your heart will be placed on your chest. A small clip (pulse oximeter) is placed on your finger to monitor your pulse and the amount of oxygen in your blood.

The surgical team uses a safety checklist to keep you safe. Below are some of the activities you can expect.

Re-confirm the correct patient

Before you are given an anesthetic, the surgical team will again confirm that you are the right patient. You will be asked your name and other identifying information possibly many times. Someone will make sure that you have a wrist band on that has your name, any allergies you may have, and other important information about you. This information will be checked before you go for your surgery.

Re-confirm the correct surgical location

Before your surgery, your surgeon will verify with you the location on your body where the operation will occur and will use a marker to initial the spot.  If you are having a regional block before your surgery, the site where the block will be done will be marked by the anaesthetist before the procedure.

A "time out" and a "briefing session" inside the operating room

The surgical team will again confirm that you are the right patient. The side of your body and site of your surgery will be talked about out loud and everyone will agree that this is correct. All important information about you will be reviewed by the team out loud. This is to make sure that the operating room team understands and agrees with what is going to happen. The team will discuss the important steps in your surgery, your medications, allergies or any special needs you may have during your surgery.

Debrief after surgery

Before you leave the operating room, the team will talk about what happened during your surgery and will confirm where you are to go to recover.

Your surgery may take more or less time than your physician estimated. If your surgery takes longer, it does not mean that anything is wrong. Your family will be told how you are doing. Once your surgery is over, the physician will come to the waiting room to talk to your family.

Monitoring your recovery

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. A nurse will check your vital signs and bandages. You may still have tubes and monitors connected to you.  You will be awake, but you may feel very sleepy or like you are in a dream. You may have a sore throat, headache or muscle pain. The nurse will ask about your pain level. The length of time you are in the recovery room will depend on the type of surgery and how much you respond to the anesthetic. It is common to not remember much of your time in the recovery room. You will then be moved to a hospital room or you will go home.

Managing your pain

Your nurse will help to take care of any discomfort you may have. Pain can be managed in several ways. These include pills, injections, patient controlled analgesia (PC) pumps and epidural injections. Your surgeon and/or anesthesiologist will decide which the best method is for you depending on the type of surgery you have. Pain medications work best when taken at regular intervals and before the pain gets too bad. Do not hesitate to tell your nurse when you are getting uncomfortable. It is important to be honest about how much pain you have – not to minimize it or exaggerate it. You should be comfortable enough to turn, move your arms and legs in bed and to do deep breathing and coughing exercises.

Going home

Whether you go home a few hours or several days after your surgery the nurse will:

• Help you get dressed if required.
• Give you any discharge instructions on how to take care of yourself when you go home.
• Review which medications you are to take and when, including medicines you take regularly.
• Review your care instructions with you. (Wound care)

It is particularly important for you to ask the surgeon or nurse what signs or symptoms you might expect, what is normal, what is cause for concern, and what you should do if you are concerned.

Please remember that the effects of the anesthesia medications go away very slowly.  Do not plan on doing anything important the day of or day after surgery.  You will feel drowsy for hours after the surgery.  For these reasons, you MUST NOT drive a car, work with machinery or sign any important papers for at least 24 hours.

Ensure that you have all of your belongings and any medications or valuables with you before you leave the hospital.

On returning home

• Follow the instructions given to you
• Fill any prescribed medications and take as directed
• Make/keep appointments for follow-up care with your doctor
• Contact your doctor, a walk-in clinic, HealthLink BC at 811, or the Emergency department for any problems.

General surgery

General surgery is a surgical specialty that focuses on abdominal organs, e.g. intestines including esophagus, stomach, colon, liver, gallbladder and bile ducts, and often the thyroid gland, breast surgery and hernias.

Learn more: General Surgeons of BC

Gynaecology

Gynaecology refers to the surgical specialty dealing with the health of the female reproductive system (uterus, vagina and ovaries).

Learn more: Society of Obstetricians and Gynaecologists of Canada

Ophthalmology (eyes)

A medical specialty focusing on the diagnosis and treatment of disorders of the eye.  Conditions include cataracts, glaucoma, and conjunctivitis, among others.

Learn more: Canadian Ophthalmological Society

Oral and maxillo-facial surgery

A dental specialty focusing on the diagnosis and surgical treatment of diseases, injuries and defects of the mouth, teeth and gums. Examples of oral surgery include removal of wisdom teeth, facial injury repair and repair of uneven jaws.

Learn more: Canadian Association of Oral and Maxillo-facial Surgeons

Orthopaedics

The medical specialty dedicated to the diagnosis, treatment, rehabilitation, and prevention of injuries of the musculoskeletal system including the muscles, bones, joints, ligaments, tendons, and nerves.

Learn more: Canadian Orthopaedic Foundation "Patient Education" and "Patient Resources"

Otolaryngology - Ears, Nose and Throat (ENT)

Otolaryngology is the medical and surgical treatment of the head and neck, including ears, nose and throat.

Learn more: The Canadian Otolaryngological Society

Plastics and reconstructive

A surgical specialty that focuses on the repair, restoration or improvement of conditions or injuries to the skin and external features.

Learn more: Canadian Society of Plastic Surgeons

Urology

A surgical specialty that deals with problems affecting the urinary tract including kidneys, bladder, and prostate.

Learn more: Canadian Urological Association

• Northern Health assigns an allotted amount of surgery time to each surgeon.
• Once a surgeon sees a patient, their office submits a booking request to the OR booking office. A patient's waiting time for surgery is directly linked to their classification (elective, urgent and semi-urgent). Your surgeon's office can advise you of your classification.
• It has been our experience that surgeon's offices are not able to give any sort of accurate estimate other than an approximation of months due to the fluidity of their waiting lists. Surgeons' offices have cancellation lists, which you can ask to have your name placed on.
• If you feel your surgical condition has deteriorated, it is important that you bring these concerns to the attention of your surgeon. They may be able to update your priority level, if appropriate. You may also wish to ask whether he has a cancellation list to which you can be added if you are available at short notice. Alternatively, you may wish to ask your family physician to refer you to a different surgeon nearby who may have a shorter wait time.
• Increasing levels of pain should be brought to the attention of your family doctor so this can be addressed.

Surgical Wait Times website

The Ministry of Health has a Surgical Wait Times website that is designed to offer you more information about wait times for elective surgical procedures in British Columbia for adult and pediatric patients. This waitlist data is based on cases that have been completed which does not reflect people who are still waiting.

Northern Health continually monitors and tracks data and information to assess how well the organization is meeting its goals and objectives.

If you have cataracts, you may notice that your eyesight is getting worse and that it is not better with glasses or contact lens. If it’s hard for you to do regular activities because of your eyesight it may be time for cataract surgery.

In cataract surgery, the cloudy, natural lens is removed from the eye and, in most cases, a plastic lens replaces the natural lens to return eyesight. 

Lens replacement

Most replacement lenses are made of a flexible material and are smaller than a dime.

There will be significant cost savings to patients requiring lens replacement following cataract surgery.

• Foldable, monofocal lens (the most common type of replacement lens) will be free to patients covered through the Medical Services Plan.
• Patients who need cataract surgery will not pay for lens as long as they choose an insured lens (foldable monofocal lens). This includes consultation, visits, and testing for insured lens.

With cataract lens replacement, several types of lenses are available to help people enjoy better vision. These include the insured monofocal lenses (used by about 90% of patients in BC) which offer vision at one distance only. Specialty lens may also correct other vision problems, allowing you to see without glasses or contacts. Speciality lens can be bought for an additional cost.

Choosing a non-insured (specialty) lens

If you want a specialty lens, you can buy these from Northern Health. You pay only the difference between the cost of the insured lens and the non-insured specialty lens you choose. Your ophthalmologist's office will give you instructions on how and where to pay for the additional cost of the non-insured lens. Payment must be received prior to your surgery.

What is an intraocular lens?

Cataract surgery involves removing a cloudy lens from the eye and replacing it with a clear plastic lens to restore vision. These implanted lenses are referred to as intraocular lenses.

There are two basic types of intraocular lenses: rigid and foldable. Rigid lenses are an older version; foldable lenses are more updated technology.

The most commonly used lens is also called monofocal, which is similar to the natural eye lens. However, multifocal lenses exist to correct not only cataracts, but also correct certain eye conditions.

What lens is considered the standard of care for cataract surgery?

In June 2012, the government of British Columbia decided to make foldable monofocal lenses the standard of care for cataract surgeries. The decision was based on a review of the most commonly-used lenses as well as discussions with ophthalmologists, clinical experts and patients. Foldable monofocal lenses are used by about 90 per cent of patients in BC.

How much will I pay if I choose a foldable monofocal lens?

Nothing. There is no cost to you if you choose a foldable, monofocal lens for your cataract surgery. The lens, surgery and doctor services are covered by your medical services plan. You should not pay the surgeon or the hospital any fee.

How much will I pay if i choose a non-insured specialty lens?

You will have to pay the difference in price between the standard monofocal lens and the specialty lens you choose. You will not pay the full price of the specialty lens.

If I choose a specialty lens, how do I pay the cost difference?

If you decide to purchase a specialty lens for your cataract surgery, you will pay the health authority directly. You can pay at the cashier’s office at the hospital sites.

Will specialty lenses become insured in the future?

No. Your medical services plan covers what is medically-required to fix your cataract. Specialty lenses are not needed for cataract surgery. They correct your vision so that you won’t have to wear eyeglasses.

Have prices changed for specialty lenses?

No. But as of Monday, May 13, 2013 all health authorities will pay a lower price for the standard monofocal foldable lenses through a provincial contract with lens suppliers. This is saving our health care over four million dollars each year.

Will my doctor have other brands of lenses that I can buy?

Health authorities must purchase and supply all lenses that are used in publicly-funded cataract surgeries. This means that doctors do not purchase or sell lenses directly to patients.

How many people have cataract surgery in BC?

In 2010/2011 there were 51,887 cataract surgeries in British Columbia. We expect that about 90 per cent of patients will receive the free-of-charge monofocal foldable lenses for their cataract surgery.

Research shows that people who are well prepared and fully participate in their care, have a smoother and faster recovery after joint replacement surgery. Preparing for surgery involves getting yourself and your home in the best possible shape. During the wait for surgery, it is important that you strive to maintain and improve your health and fitness.

Download and follow the guideline below, to get you in the best possible shape for surgery and recovery.

• Before, during and after hip and knee replacement surgery (Remember to bring the guide with you to the hospital.)

Note: If there is a difference between this guide and instructions from your surgeon, family doctor or orthopedic team, follow the instructions specified by your surgeon/doctor/team.

Learn how you can help

It is really important for people having surgery to have friends and family members to offer support and assistance. Having surgery can be stressful and medications can impair memory and clear thinking. Accompany the patient to the appointments with the surgeon and at the pre-surgical screening clinic. Listen carefully, ask questions, and write information down, so you and the patient can review later.

Bring the patient home safely

It is not safe for surgical patients to go home alone as surgery causes stress on the body and anesthetic drugs can stay in the body for up to 24 hours. Arrange to drive or accompany the patient home in a taxi or on a bus.

Get enough sleep

Make sure both you and the patient get a good night's sleep and for the patient to rest quietly several times each day. Help by coordinating visitors and encouraging nap time. Check with the nurse for the hospital visiting hours.

Arrange for help at home

If the patient needs nursing care or assistance bathing, the care team at the hospital will make a referral and arrangements with Home Care.

Take care of yourself

It is very important to take care of yourself and find rest and a break from care giving. Don’t be afraid to ask for help from other friends, family members or neighbours. If you'd like to talk to someone about your own emotions or fears, speak with a hospital social worker or your family doctor.

Call for help in an emergency

If the surgical patient:

• Faints or won’t wake up
• Has sudden severe pain that gets worse even with pain medication
• Feels cold but is sweating
• Starts shaking

Call 911 for an ambulance and do not allow the patient to eat or drink anything

If the surgical patient:

• Has blood or fluid soaking through their bandages*
• Gets a fever
• Or if you have any other concerns

Call the surgeon, call 811 to get advice from a nurse, or drive the patient to the emergency department. Patients should not drive themselves.

*If blood or fluid is soaking through the bandages, fold up a clean towel and place it on top of the bandage. Do not take off the bandage to look at the wound. Hold the towel in place firmly, but do not tie the towel on or put tape all around an arm, leg, chest, waist, etc.