UNIVERSITY OF UTAH ORTHOPAEDIC SURGICAL SERVICES

UNIVERSITY OF UTAH ORTHOPAEDIC SURGICAL SERVICES University Hospital 50 N. Medical Drive Salt Lake City, UT 84132 University Orthopaedic Center 590 Wakara Way Salt Lake City, UT 84108 Farmington Health Center 165 N. University Avenue Farmington, UT 84025

OVERVIEW Welcome Your Surgical Care Team Preparing for Surgery Optimize Your Health Choosing Your Support Team Preparing Your Home Insurance Authorization Patient Checklist Two Weeks Before Surgery The Day Before Surgery Things to Bring Things to Leave Pain Management Understanding Your Pain Pain Management Distraction Method for Pain Control Red Flags Your Recovery Back at Home Blood Clots Signs of Infection Returning to Work Page 2 of 20 U of U Health Orthopaedic Surgical Services

WELCOME Quality of life means different things to different people. Whether it is spending time with family, working on projects, or enjoying various physical activities such as golfing, hiking, or biking, being able to stay active is essential to a good sense of qualify of life and healthy living. The University of Utah Orthopaedic Center provides quality orthopaedic care for patients through all walks of life through physicians and staff who are leaders in their field. With dedication to extensive patient education and a comprehensive continuum of care, our goal is to ensure patients have the proper information, care and support they need every step of the way. The relationship you have between the surgeon, staff and your support system is vital to the success of your surgery. Our surgeons will deliver quality care through your experience with us, but ultimately, you will play the biggest role in your successful recovery. This booklet was designed with the patient in mind; informative, concise, and a quick reference for you before and after surgery. Becoming familiar with this booklet prior to surgery will help guide you through your surgical journey. Keep in mind that this is a basic template and follow up that may change based on your surgery, recovery progress and life circumstances. We know you have a choice in your health care, and are honored you have chosen us to care for you. We hope you have a smooth recovery and successful outcome. Page 3 of 20 U of U Health Orthopaedic Surgical Services

YOUR SURGICAL CARE TEAM Attending The attending is the medical doctor and surgeon who provides and coordinates your care. The attending oversees fellows and residents as they make decisions in your care. Fellow A medical doctor who has completed specialty training and is board eligible in Orthopaedics. A fellow can function as an attending, but is part of a yearlong program focusing primarily on one area of Orthopaedics. A fellow will see you in clinic and work with your surgeon in your care. He or she assists the attending in surgery and visits patients while in the hospital. Resident A medical doctor completing specialty training in the field of Orthopaedics. Our residents are part of a five-year residency program and in years two through five of their residency. Residents see patients in clinic and present these patients to the attending before making a decision in your care. They assist in the surgery and visit patients daily while in the hospital. Physician Assistant (PA) A health care professional with licensing and credentials, allowing them to practice medicine under a medical doctor s license. You may be seen by the PA for follow-up appointments and they may also assist the attending in surgery. Registered Nurse (RN) A health care professional with licensing to provide a broad range of patient care and discuss medical questions with you and direct your care under the supervision of the surgeon and team. Athletic Trainer Certified (ATC)/Orthopaedic Technologist Certified (OTC) A health care professional with licensing that specialize in sports medicine. Athletic trainers may see patients in clinic and present them to the attending for decisions regarding care. Athletic Trainers that possess Orthopaedic Technologist Credentials may also assist the attending in surgery. Page 4 of 20 U of U Health Orthopaedic Surgical Services

Medical Assistant (MA) Medical Assistants are certified medical professionals who work in the clinic and keeps things running smoothly. They are the ones who will bring you back to the clinic room and get you prepped to see the attending. They are responsible for processing paperwork ranging from work notes, FLMA paperwork, medication refills, physical therapy prescriptions, appointments and various questions related to your care. Page 5 of 20 U of U Health Orthopaedic Surgical Services

PREPARING FOR SURGERY EDUCATION An important step to prepare for surgery is to make sure you understand the surgery. Some questions to ask yourself are: Do you understand the procedure and why it can help you? Do you understand the potential risks? Do you understand the alternatives and what is likely to happen if you do not have the surgery? Do you understand the plan for anesthesia during the surgery? Do you understand the plan for pain management after surgery? Do you understand the instructions for surgery? Do you understand the recommended limitations during your recovery? We want to make sure all of your questions are answered before surgery. Please make sure to read this booklet carefully and if you still have questions, please don t hesitate to contact us. OPTIMIZE YOUR HEALTH MEDICAL CLEARANCE For young healthy individuals with no known medical issues, screening of one s medical history by nursing staff will occur prior to surgery. A visit to your Primary Care Physician (PCP) within 3 months prior to surgery for a general health checkup is recommended for patients with any ongoing medical issues. We want to give them the opportunity to ensure that any health concerns have been addressed before proceeding with your surgery with as little additional risk as possible. If you have other significant medical conditions you will need to see relevant specialists for medical management prior to surgery. SIGNIFICANT MEDICAL CONDITIONS THAT MAY REQUIRE ADDITIONAL TESTING OR CLEARANCE BEFORE SURGERY: If you have any of these conditions notify your surgeon to determine if anything should be done in advance of surgery. Heart conditions/surgery Lung conditions/surgery Sleep Apnea Supplemental Oxygen Kidney problems Page 6 of 20 U of U Health Orthopaedic Surgical Services

Stroke (CVA) Diabetes Blood Thinners (Coumadin, Plavix, Ticlid, Pradaxa, Effient etc) You must contact your prescribing physician and/or surgeon for further instruction. Any Cold/Cough symptoms within 6 weeks of surgery Rheumatoid Arthritis medications (these may or may not need to be stopped for 2-3 weeks) Taking Aspirin-type medications (NSAIDs) consult the MA for your surgeons protocol History of MRSA/post-operative infections EXERCISE We understand that you may be physically limited by your condition, so we encourage you to focus on strengthening the parts of your body not effected by your planned surgery. Some types of surgeries may require physical therapy beforehand. Make sure you attend your physical therapy as recommended and perform the home exercises your physical therapist gives to you. The healthier you are prior to surgery, the easier the overall recovery process may be. NARCOTIC MEDICATIONS If you are taking narcotic pain medication such as Lortab, Norco, Percocet, Oxycodone, Hydrocodone, Dilaudad prior to surgery, decrease your use as much as possible at least 4 weeks before surgery. Tapering off your narcotic pain medications prior to surgery will help us control your pain in the postoperative period. If your body is tolerant to high doses of pain medication before surgery, it may be more difficult to control your pain after surgery. SMOKING QUIT SMOKING at LEAST 6 WEEKS BEFORE & AFTER SURGERY Nicotine decreases the blood supply to your surgical site and slows down the entire healing process. If you continue to smoke, your surgery may be cancelled. Resources: 1-800-QUIT NOW (784-8669) becomeanex.org smokefree.gov utah.quitnet.com waytoquit.org Page 7 of 20 U of U Health Orthopaedic Surgical Services

DO YOU HAVE ANOTHER SURGERY OR PROCEDURE SCHEDULED? If you are being scheduled for an invasive procedure or another type of surgery please contact your surgeon to find out if there is a time frame you should consider waiting before or after surgery. CHOOSING YOUR SUPPORT TEAM We ask all of our patients to identify your support team prior to their surgery date. Your support team can be friends, family members, or neighbors; people who you know and trust, who are willing to help you for your first few days at home after surgery. Most importantly, your support team will help you with daily activities as you recover. This can be one person, or it can be several people, it does not matter as long they communicate any needs you may have. Your support team may help you get food and medication, and perform other basic household tasks after your surgery. They will also help remind you of the exercises you will be doing during recovery, and should be available as an extra set of eyes and ears to support you during your first days back home. After surgery, you will be able to bathe and use the bathroom independently, but be sure to communicate with your support system if you do decide that you need an extra hand. Include your support team in your home preparations, if possible. The more communication you have with them prior to surgery, the better equipped they will be to assist you when you return home. Page 8 of 20 U of U Health Orthopaedic Surgical Services

PREPARING YOUR HOME FOR RECOVERY It is important to consider the layout and organization of your home in preparation for your surgery. We want your return home to be as smooth and comfortable as possible. We recommend you try moving around your house with the equipment you will need for your recovery (ex. Walker, crutches), to help you get a sense of possible challenges or barriers that you may not have noticed otherwise. Things to consider: Are there stairs in your home? o You will be able to navigate stairs after surgery, but fewer is better. o If possible, arrange for a bed, a place to sit, and a bathroom all on the same floor of your home. Rearrange your furniture to make space for crutches and/or a walker, if necessary. Look for objects that you frequently use. Will you need them while you recover? Can you reach them with ease now? How might that be different while you re recovering? Throw rugs can be a trip hazard, especially in the bathroom. If you have any, pick them up and put them away. Low seats can be difficult to get out of initially. Find firm pillows to raise seats up, and keep extras on hand to help elevate your operative area while you re in bed. Consider the following medical supplies to aid in your daily living: Raised toilet seat Shower chair Safety bars in shower or near toilet Prepare and freeze meals ahead of time to make cooking easier once you return home. Page 9 of 20 U of U Health Orthopaedic Surgical Services

INSURANCE AUTHORIZATION Your insurance company will be notified of your upcoming surgery 30-45 days prior to your surgery date. We will make every effort to pre-authorize your surgery, and to provide any requested information to your insurer. We are pleased to offer the services of a University of Utah Patient Financial Advocate to provide an estimated cost for your surgery, to assist you with billing questions, and/or establish a payment plan if you are uninsured. If there are any issues obtaining authorization for surgery, a financial advocate will contact you prior to your surgery to go over your options. Financial Advocates: University Orthopaedic Center (801) 587-5374 University Hospital (801) 581-2957 Please contact your insurance company to verify that you have coverage for both the facility and the surgeon. Be sure to ask if this is in network (IN) or out of network (OON). Understand what each one means for your coverage. University Orthopaedic Center & University Hospital NPI: Facility Tax ID: Farmington Health Center NPI: Facility Tax ID: Surgery dates are subject to change, pending insurance authorization Page 10 of 20 U of U Health Orthopaedic Surgical Services

PATIENT CHECK LIST TWO WEEKS BEFORE SURGERY A pre-operative nurse will be contacting you to review your medical history and medication list. These nurses will let you know if you are taking any medications that should be stopped to prevent from interfering with surgery. This phone call is mandatory to ensure your safety for surgery. If you have direct questions for our nurses, please call 801-587-5343 Arrange for your ride home after surgery, plan to have an adult 18 years or older drive you to and from surgery. For your safety and comfort, it is important for an adult to be with you for at least 24 hours after surgery Check with surgeon regarding any blood thinners you take Please clear your schedule the day of surgery. Your surgery arrival time is set the business day before surgery Get any ambulation devices, crutches/walker (if your surgery is on your hip, leg, knee, ankle, foot) that you may need and become familiar with its use. The Orthopaedic Center Physical Therapy department offers crutch training on a walk in basis Schedule your Physical Therapy for after surgery if your surgeon tells you that you ll need it. Physical Therapy can book up far in advance so get an appointment scheduled once you know you ll need it THE DAY BEFORE SURGERY Your Arrival If your surgery is at The University Hospital: Please call 801-585-1449 after 2pm for your surgery check in time. If your surgery is at The University Orthopaedic Center: You will receive a call with your surgery check in time. Please expect this call sometime between the hours of 2:30pm-5:00pm MST. If you haven t heard from anyone by 4pm, feel free to call the surgery check in desk at 801-587-5373. If your surgery is at Farmington Health Center: A nurse will call you between 2pm and 6pm with your surgery check-in time. Do s & Don ts Make sure you are well hydrated and to drink lots of water the day before surgery Page 11 of 20 U of U Health Orthopaedic Surgical Services

Do NOT eat or drink anything the morning of your surgery, starting after midnight. If arrival time is after 11am you may be given modified instructions permitting clear fluids up until a certain time for the day of surgery. Clear fluids are: water, Gatorade, soft drinks, broth, or jello. No milk, dairy, or pulp juices (orange, grape, etc.). No chewing tobacco, gum or mints. It is OKAY to brush your teeth, without swallowing the water. You must have a ride home with a responsible adult, ideally, one of your support team members. Make sure you double check with your ride or plan your ride if you have not already done so. Someone from your support team should be with you the rest of the day and night. THE DAY OF SURGERY THINGS TO BRING THE DAY OF SURGERY ü This Education Booklet ü Photo ID ü Co-pay if required ü Current Insurance Information & Card ü Wear Loose clothing ü Skid-proof slippers/tennis shoes to wear home ü Socks and loose undergarments ü Toiletries (include a case for contacts lenses, if you wear them) ü Paper and pencil to write questions or take notes. ü Advanced Directives/Living will ü Small hand held electronic devices if desired ü Adult member of your Support Team o They may bring a laptop or handheld device to keep them comfortable while they wait for you o Our surgeons prefer that they stay in the building throughout the surgery in case they need to provide updates. However, if they need to leave (patient must be over 18), we ask that they provide a contact number where they may be reached. THINGS TO LEAVE AT HOME Do not wear any eye makeup Large amounts of money Tight-fitted clothing Valuables Jewelry (this includes body piercings) Page 12 of 20 U of U Health Orthopaedic Surgical Services

Personal electric equipment (razor, blow dryer, etc.) If you are staying overnight: Surgery at University Orthopaedic Center ü Bring ALL medications in original bottles with you on day of surgery ü CPAP for sleep apnea Surgery at Main Hospital ü Do NOT bring your medications. The hospital has the majority of medications available ü CPAP for sleep apnea Page 13 of 20 U of U Health Orthopaedic Surgical Services

PAIN MANAGEMENT AND EXPECTATIONS Allow 24 48 hours for any refills or prescription requests, call us before you run out. UNDERSTANDING YOUR PAIN Pain is real. So is addiction. The CDC reports that overdose death from prescription opioids has more than quadrupled since 1999. While these medications may have a place in post-operative pain management, they must always to be taken as prescribed and weaned off of as soon as possible. It is important for patients to understand their pain and understand that the goal is not to be pain free in the weeks after surgery, but to have pain that is manageable and tolerable. PAIN MANAGEMENT After most surgeries, your surgeon will prescribe you narcotic pain medication Lortab, Norco, Hydrocodone, Percocet, Oxycodone, dilaudad are common pain medications. If you are prescribed pain medication, it will be for a maximum of six weeks should be taken as prescribed and weaned off of as soon as you are able. You should not take narcotic pain medication if you have very little pain. You should reduce your use of narcotics as soon as your pain allows. Ice, rest, and elevation can help manage the pain as a substitute for medication. When your pain is not severe, do not take the full dose of narcotic pain medication. First, take acetaminophen to see if it will be enough to control your pain. If it is NOT effective, you can take more narcotics at that time. DISTRACTION METHOD FOR PAIN CONTROL Distraction means shifting or moving your attention away. It does not mean that the pain is no longer there, it just means that you use your brain to focus your attention onto something else. You can put your pain in the background and focus instead on playing games, counting, using breathing techniques and many other activities. One of the things that you can do to limit the amount of time you spend worrying about or being afraid of pain, is to use distraction. Substitute non-narcotic pain medication, like Tylenol (acetaminophen,) when possible. Medications such as Percocet or Norco already contain acetaminophen, so be sure to check your prescriptions so you do not consume more than 3000 mg of acetaminophen per day. Page 14 of 20 U of U Health Orthopaedic Surgical Services

Frequently Prescribed Medications Brand Name Generic Name Category Purpose Duration Senna, Colace Senna, Docusate Stool softener Prevent severe constipation that commonly comes Norco Vicodin Percocet Oxycontin Roxicodone Hydrocodone Oxycodone Narcotic Pain Reliever Narcotic Pain Reliever Celebrex Celecoxib Antiinflammat ory, safe with warfarin Naproxen Naprosyn Antiinflammat ory Ultram Tramadol Pain reliever, nonnarcotic Tylenol Acetaminophen Pain reliever, fever reducer with narcotics. Relieves severe pain Relieves severe pain Decrease the swelling and pain from the trauma of surgery Decrease the swelling and pain from the trauma of surgery Relieves mild to moderate pain Relieves mild pain, and if taken regularly can reduce the need for narcotics Lyrica Pregabalin Nerve pain Relieves nerve and Aspirin Aspirin Antiplatelet Coumadin Warfarin Anticoagulant muscle pain Prevention of blood clots in average risk patients Prevention of blood clots in higher risk patients Page 15 of 20 U of U Health Orthopaedic Surgical Services

RED FLAGS Since every surgery has certain risks, we want to make sure that our patients know the signs and symptoms that something may not be right. Please contact your medical team immediately if you experience any of the following symptoms: Fever of over 101 degrees F Shaking chills Bleeding that cannot be controlled with dressing reinforcement and pressure Difficulty breathing or chest pain Swelling, tenderness in the calves Excessive nausea/vomiting Any signs of infection (See Signs of Infection in Recovery section) Urgent After Hours: (801) 581-2121 Ask for the orthopaedic resident on-call Page 16 of 20 U of U Health Orthopaedic Surgical Services

RECOVERY YOUR FIRST DAYS AT HOME After your discharge from the hospital, you will need some assistance for the first few days at home. During this time, your support team should plan to help with shopping, housework, and other activities of daily life. DIET Unless instructed otherwise by your surgeon, resume a regular diet as soon as possible. Start with clear liquids and light foods such as Jello or soup. Once the nausea from anesthesia has resolved, a diet rich in fruits, vegetables and fibrous foods is strongly recommended to give your body the nutrients needed to heal. CONSTIPATION The narcotic pain medications you may be taking after surgery, often causes constipation. To help reduce the discomfort that constipation can cause, all patients prescribed narcotics will also be prescribed a stool softener and we encourage you to be proactive about your diet. You should never go more than 4 5 days without a bowel movement (including the time you spent in the hospital). To avoid constipation and encourage a bowel movement: Drink plenty of water (minimum of 64 ounces per day) Increase fiber intake by eating dried and fresh fruit, whole grains, vegetables, bran, psyllium, apple juice, or prune juice Use stool softeners such as Colace, Metamucil or Miralax as needed Use Fleet enema or a warm water enema Depending on your pain level, consider decreasing or stopping your narcotic pain medication Continued constipation can lead to emergency trips to the hospital. Please contact our office if you are concerned about the amount of time you have gone without a bowel movement. ICE AND ELEVATION Swelling in your operative site is normal, and should decrease over time. Applying ice several times a day for 30 60 minutes at a time can help reduce swelling and assist with pain control. Heat is not recommended, as it can Page 17 of 20 U of U Health Orthopaedic Surgical Services

increase swelling. Proper elevation means that the affected limb should be above your heart. (pictured) NAUSEA Many people find pain medication can make them feel nauseous or cause vomiting. Taking your pain medication with food and water can help avoid these side effects. If you are experiencing nausea or vomiting, please let us know, as there are things we can do to help. (antinausea meds) SLEEP Getting back to a normal sleep pattern after your surgery can be difficult. If you are having trouble sleeping at night, try to avoid napping during the day. Elevate your surgical site in the early evening and do a quiet activity, and schedule your pain medication so you can take pain pills one hour before bed. If you are still struggling to sleep, consider taking Benadryl (diphenhydramine), an allergy medication with a side effect of drowsiness. BLOOD CLOTS Blood clots or deep vein thrombosis (DVT), can result from multiple factors after surgery. A primary cause of DVT is not getting up and moving around after your surgery. Various measures that can be used to reduce the possibility of blood clot include: TED hose (special anti-embolism stocking) Blood-thinning medications Minor exercises such as ankle pumps Routine walking If you experience one of the following signs and symptoms of a DVT or pulmonary embolism (PE), please let a member of your care team know immediately: Large amounts of swelling in an extremity Cramps in your calf or lower leg Immediately go to the Emergency Room if you experience: Sharp and/or sudden chest pain Difficulty breathing or shortness of breath If you have a history of blood clots, please make sure you inform your surgeon of this before and on the day of surgery. Page 18 of 20 U of U Health Orthopaedic Surgical Services

SIGNS OF INFECTION Some signs and symptoms of infection are: high fever, redness and around the surgical site hot to the touch around the surgical site pus draining from the incision night sweats or chills sever tenderness around the incision It is common to experience a mild fever during the first few days after surgery as well as nausea, light-headedness and dizziness. Those are usually effects of the anesthesia and should resolve within a few days. RETURNING TO WORK Most people return to work 2 6 weeks after their surgery depending on the demands of their job. Desk jobs or other sedentary work can be resumed quite promptly, while work that involves significant lifting or other heavy labor are generally not resumed till later. Work closely with your surgeon s team to determine when you are ready. FMLA paperwork can be submitted to your surgeons MA prior to surgery. Page 19 of 20 U of U Health Orthopaedic Surgical Services

IMPORTANT DATES Pre-Op Clearances/ Appointments/ Classes: - SURGICAL DATE: CHECK IN TIME: University Hospital 50 N. Medical Drive Salt Lake City, UT 84132 University Orthopaedic Center 590 Wakara Way Salt Lake City, UT 84108 Farmington Health Center 165 N. University Avenue Farmington, UT 84025 Post-Op Appointments: Post-op appointment: / / at a.m. / p.m. Provider Location Post-op appointment: / / at a.m. / p.m. Provider Location Post-op appointment: / / at a.m. / p.m. Provider Location Post-op appointment: / / at a.m. / p.m. Provider Location Post-op appointment: / / at a.m. / p.m. Provider Location *Reminder: You will receive your check in time for surgery on: Date: Urgent After Hours: (801) 581-2121 Page 20 of 20 U of U Health Orthopaedic Surgical Services