Patient Resources
Preparing for Surgery
Everything you need to know before your procedure — medications to stop, what to bring, how to prepare your body, and how your family can help. Print this page or save it to your phone.
Northside Hospital Pre-Surgery Line: (678) 312-2443
A Northside pre-surgical assessment nurse will call you before your surgery to review your medical history, medications, and provide specific instructions for your procedure. This call usually comes 1–3 business days before surgery.
If you have questions about anesthesia, fasting, or day-of-surgery logistics at Northside Hospital Gwinnett, Duluth, or the Outpatient Surgery Center, call (678) 312-2443.
Critical — read carefully
Medications to Stop Before Surgery
Some medications increase bleeding risk or affect anesthesia. Dr. Kakarla will give you specific, personalized instructions — the information below is general guidance. Always confirm your stop dates with our office.
Blood Thinners
These medications must be stopped before surgery to reduce bleeding risk. The exact timing depends on which medication you take:
- Eliquis (apixaban) — typically stopped 2–3 days before surgery
- Xarelto (rivarelbanan) — typically stopped 2–3 days before surgery
- Warfarin (Coumadin) — typically stopped 5 days before; may need bridging with Lovenox
- Plavix (clopidogrel) — typically stopped 5–7 days before surgery
- Aspirin — Dr. Kakarla will advise whether to stop or continue; depends on your cardiac history
- Pradaxa (dabigatran) — typically stopped 2–3 days before surgery
When to restart: Dr. Kakarla will give you specific restart instructions, usually 24–48 hours after surgery depending on the procedure and your bleeding risk. Do not restart on your own — wait for our instructions.
GLP-1 Medications (Weight Loss / Diabetes)
GLP-1 receptor agonists slow stomach emptying, which can be dangerous with general anesthesia (aspiration risk). These must be stopped well in advance:
- Ozempic (semaglutide weekly) — stop 2–4 weeks before surgery
- Wegovy (semaglutide weekly) — stop 2–4 weeks before surgery
- Mounjaro / Zepbound (tirzepatide) — stop 2–4 weeks before surgery
- Trulicity (dulaglutide) — stop 2–4 weeks before surgery
- Rybelsus (oral semaglutide) — stop at least 1 week before
If you are on a GLP-1 for diabetes (not just weight loss), talk to your prescribing doctor about alternative blood sugar management during the gap.
Supplements & Herbal Medications
Many supplements increase bleeding risk or interact with anesthesia. Stop ALL supplements and herbal medications 7–10 days before surgery, including:
- Fish oil / omega-3 fatty acids
- Vitamin E (high dose)
- Garlic supplements
- Ginkgo biloba
- Ginseng
- Turmeric / curcumin
- St. John’s Wort (interacts with anesthesia)
- Kava (liver and anesthesia interaction)
- Green tea extract (high dose)
A daily multivitamin is generally fine to continue. If in doubt, bring the bottle to your pre-op appointment and ask.
Birth Control & Hormone Therapy
Estrogen-containing medications (combined birth control pills, patches, rings, and hormone replacement therapy) increase blood clot risk during and after surgery. Dr. Kakarla or your prescribing physician may recommend:
- Stopping estrogen-containing contraceptives 4 weeks before major surgery
- Switching to a progestin-only option temporarily
- Using alternative contraception during the gap
Progestin-only pills, IUDs, and implants do not need to be stopped. Discuss your specific situation with our office.
Other Medications to Discuss
- Diabetes medications (metformin, insulin) — special instructions for surgery morning; bring your glucose monitor
- Blood pressure medications — most should be taken the morning of surgery with a small sip of water
- Anti-anxiety medications — may be taken morning of surgery; discuss with us
- Inhalers (asthma/COPD) — bring to the hospital; use as normal
Golden rule: Bring a complete list of every medication and supplement you take to your pre-op appointment. We will review each one individually.
The night before
Night Before & Morning of Surgery
Eating & Drinking (NPO Rules)
- No solid food after midnight the night before surgery
- Clear liquids only (water, black coffee, apple juice, Gatorade) until 2 hours before your arrival time
- Nothing at all — not even water — within 2 hours of arrival
- If you accidentally eat or drink, call our office immediately — your surgery may need to be rescheduled for safety
Why this matters: An empty stomach prevents aspiration (food entering your lungs) during anesthesia. This is a strict safety requirement.
Antiseptic Shower
Shower with Hibiclens (chlorhexidine) antiseptic wash the night before and the morning of surgery:
- Apply from the neck down, focusing on the surgical area
- Let it sit on the skin for 2 minutes before rinsing
- Do not use it on your face, hair, or genital area
- Do not apply lotions, powders, or deodorant after the antiseptic shower
- Hibiclens is available at any pharmacy without a prescription
This reduces skin bacteria and lowers surgical site infection risk.
Shaving
Do NOT shave the surgical area yourself. Razor nicks create microscopic cuts that increase infection risk. If hair removal is needed, the surgical team will use clippers at the hospital immediately before your procedure.
Day of surgery
What to Bring & What to Leave Home
Bring
- Photo ID and insurance card
- Complete list of medications (or bring the bottles)
- CPAP machine if you have sleep apnea
- Glasses (remove contact lenses at home)
- Comfortable, loose-fitting clothes (button/zip front — you may not want to pull anything over your head)
- Slip-on shoes (no laces — bending may be uncomfortable)
- Phone charger
- A responsible adult to drive you home (required — you cannot drive after anesthesia)
Leave at Home
- Jewelry, watches, and piercings (all must be removed)
- Valuables and large amounts of cash
- Contact lenses (wear glasses instead)
- Makeup, nail polish, and acrylic nails (interfere with monitoring equipment)
- Dentures can be worn to the hospital but will be removed before surgery
Special considerations
Medical Conditions & Special Situations
Diabetes
- Type 2 (oral medications): Skip metformin and other diabetes pills the morning of surgery. Bring your glucose monitor.
- Type 2 (insulin): Take half your usual long-acting insulin dose the night before. Do not take short-acting insulin the morning of surgery. Bring your insulin and monitor.
- Type 1: Individualized plan — discuss with our office and your endocrinologist.
Sleep Apnea
Bring your CPAP machine to the hospital. The anesthesia team needs to know about your sleep apnea. You will use your CPAP in the recovery room.
Pacemaker or Defibrillator
Inform our office before surgery. The anesthesia team will coordinate with your cardiologist if needed. Electrocautery used during surgery can interact with cardiac devices — the team will take appropriate precautions.
Smoking
If you smoke, stop at least 2 weeks before surgery (4 weeks is better). Smoking impairs wound healing, increases infection risk, and makes anesthesia more complicated. Even reducing your intake helps. We can provide resources for smoking cessation if needed.
Your well-being
Surgery Anxiety — It’s Normal
Feeling nervous before surgery is completely normal — most patients feel some anxiety. Here are some things that may help:
- Ask questions. Fear of the unknown is the biggest source of anxiety. Dr. Kakarla will explain exactly what to expect — don’t hold back.
- Understand the timeline. Knowing how long surgery takes, when you’ll wake up, and when you’ll go home reduces uncertainty.
- Talk to someone who’s been through it. Reading patient reviews can help normalize the experience.
- Ask about medication. If your anxiety is significant, a mild anti-anxiety medication can be prescribed for the morning of surgery.
- Bring a family member. Having someone with you in pre-op is comforting. They can ask questions too.
- Remember the numbers. Dr. Kakarla has performed 2,500+ robotic procedures. You are in experienced hands.
For family members
Caregiver & Family Preparation Guide
If you’re the spouse, adult child, or friend who will be helping after surgery, here’s what you need to know.
Before Surgery Day
- Stock the kitchen with easy, light meals (soup, crackers, yogurt, bananas, toast)
- Place commonly needed items at waist height (no bending or reaching)
- Set up a comfortable recovery spot — recliner or bed with pillows for propping
- Fill prescriptions in advance if possible
- Plan to take 2–3 days off work for outpatient procedures, 5–7 for major surgery
- Arrange help with children, pets, and household tasks
Day of Surgery
- Plan to be at the hospital the entire time — typically 4–8 hours total
- Dr. Kakarla will speak with you after the procedure
- Your family member will be groggy from anesthesia — bring a notebook to write down discharge instructions
- Help them into loose, comfortable clothes for the ride home
- Drive carefully — bumps in the road are felt more after abdominal surgery
First 24–48 Hours at Home
- Help with getting in/out of bed and chairs (they should not strain their abdomen)
- Manage medication schedule — set alarms for regular Tylenol and ibuprofen
- Encourage walking — short walks around the house help prevent blood clots and aid recovery
- Offer small, frequent meals rather than large ones
- Help with bathing until they can shower safely (usually 48 hours)
Warning Signs — When to Call the Office
- Fever above 101.5°F (38.6°C)
- Increasing redness, warmth, or drainage from incisions
- Pain that is worsening instead of improving after day 2–3
- Inability to keep any food or liquids down for 12+ hours
- No bowel movement for 4+ days
- New bulge at or near the surgical site
- Leg swelling, redness, or calf pain (possible blood clot)
Call (770) 962-9977 — our 24/7 answering service is available nights and weekends.
Questions About Preparing for Your Surgery?
Call our office and we’ll walk you through everything. Same-day and next-day appointments available.