7 medication questions to settle before orthopedic surgery

1. Bring every medicine into the review

Include prescriptions, over-the-counter pain relievers, vitamins, supplements, herbal products and medicines used only occasionally. Record the dose, frequency and reason for taking each one, and identify the prescriber when possible. Tell the team about recent changes and reactions. A medicine that seems unrelated to your joint can still affect preparation or anesthesia. Bring the list to both the surgical and anesthesia conversations so they start from the same information, and ask where the final reviewed version will be kept.

Sources: American College of Surgeons — Medication and Surgery

2. Ask who coordinates blood-thinning treatment

Anticoagulants and antiplatelet medicines need an individualized plan that balances bleeding and clotting concerns. The operation, reason for treatment, kidney function and any planned regional anesthesia can matter. Do not stop them because a generic handout says avoid blood thinners. Ask the surgical, anesthesia and prescribing teams to agree on the instructions, including any restart plan. If the advice differs between offices, have them resolve it directly before the procedure rather than asking you to choose which instruction to follow.

Sources: American College of Surgeons — Medication and Surgery

3. Make a diabetes and fasting plan

Ask how insulin and other diabetes medicines will be managed when meals, activity and surgery-related stress change. Different drugs require different instructions; one rule does not fit every treatment. Tell the team whether you use a pump or continuous glucose monitor and ask how these will be handled at the facility. Obtain the monitoring and contact plan for the period before and after surgery. If you do not understand a dose instruction, contact the responsible clinician rather than estimating or skipping treatment independently.

Sources: Preparing for surgery when you have diabetes

4. Discuss GLP-1 treatment and digestive symptoms

Tell the anesthesia team if you use a GLP-1 medicine, are increasing its dose or have nausea, vomiting or other digestive symptoms. The 2024 multisociety guidance says many patients can continue treatment, while higher-risk situations may require additional precautions or a delay. This is not a blanket instruction to continue or stop your medicine. Ask your anesthesia and prescribing teams for the plan that fits you, including any eating and drinking instructions. Do not substitute an older universal hold rule for their current assessment.

Sources: New Multi-Society GLP-1 Clinical Practice Guidance Released

5. Review pain, sleep and other sedating products

Tell the team about opioids, sleep aids, anxiety medicines, alcohol, cannabis and other products that may affect sedation or pain management. Be factual about usual use and prior difficulties. The purpose is to plan care, including avoiding withdrawal or unsafe combinations where relevant, not to judge you. Ask how postoperative medicines interact with what you already take and who handles refills or tapering instructions. If you have sleep apnea, make sure that information is included in the anesthesia and pain discussions.

Sources: American Society of Anesthesiologists — Surgery Preparation Checklist

6. Get exact instructions for the day of surgery

Request a written plan identifying which medicines are taken, withheld or adjusted and the timing of each change. Ask how to handle a missed dose, illness, vomiting or a change in the procedure time. Follow the facility's eating and drinking instructions rather than a general online schedule. Keep a contact number for questions that arise before arrival. If a new prescription is started after your preoperative review, notify the team so the plan can be updated rather than assumed to remain correct.

Sources: American Society of Anesthesiologists — Surgery Preparation Checklist

7. Plan the return to your usual regimen

The restart decision can depend on bleeding, eating, kidney function, glucose control and other postoperative factors. Ask who gives the final instruction and how it will be documented. Compare the discharge medication list with the preoperative list so an omission is clarified rather than carried forward accidentally. Tell our team which outside prescribers are involved and who will help you at home. A clear handoff should leave you knowing what changed temporarily, what changed longer term and which clinician owns the next review.

Sources: American College of Surgeons — Medication and Surgery

Put smoking and diabetes into the preoperative plan early

Spine-surgery guidance identifies smoking and diabetes-related factors as important parts of risk assessment. Tell the team about smoking, vaping, nicotine products, and diabetes treatment without trying to decide which details are relevant yourself. The aim is a workable preparation plan. Ask how these factors affect the proposed operation and whether they change the timing, technique, or follow-up being considered.

If you smoke or use nicotine, ask what support is available and what the surgeon recommends before and after the procedure. Clarify how cessation medicines or nicotine-replacement products should be coordinated rather than assuming they are treated the same way as smoking. Avoid using a fixed online deadline as a guarantee that risk has disappeared. Request a plan that specifies who helps you, what will be reassessed, and how the surgical team will review progress.

If you have diabetes, ask which recent results the team needs and who will coordinate perioperative medicines and glucose management. The plan should account for fasting, changes in meals, and the period after discharge. Do not independently adjust a diabetes prescription to meet a target found online. If a clinician recommends postponement to improve readiness, ask what needs to change, how it will be measured, and when the decision will be revisited.

Bring barriers into the conversation early, including access to supplies, medication costs, stress, and previous difficulty changing tobacco use. Preparation should not be reduced to a checklist handed over without support. Ask for one written plan that your surgeon, primary clinician, diabetes team, and anesthesia team can follow. This makes the next step clear and reduces the chance that separate instructions conflict shortly before the operation.

Sources: Preoperative Surgical Risk Assessment · Strong for Surgery · Spinal Fusion

Sources & further reading

• American College of Surgeons — Medication and SurgeryAmerican College of Surgeons
• Preparing for surgery when you have diabetesMedlinePlus / National Library of Medicine
• New Multi-Society GLP-1 Clinical Practice Guidance ReleasedAmerican Society of Anesthesiologists · Published October 29, 2024
• American Society of Anesthesiologists — Surgery Preparation ChecklistAmerican Society of Anesthesiologists
• Preoperative Surgical Risk AssessmentCongress of Neurological Surgeons
• Strong for SurgeryAmerican College of Surgeons
• Spinal FusionAAOS OrthoInfo

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