I have had two patients in the last month who didn’t feel that the instructions regarding avoidance of medications prior to surgery made any difference.  I routinely give a 2 page instruction sheet to patients telling them to avoid medications such as aspirin, ibuprofen, and motrin.  My office staff reviews the importance of this with every patient.  During every preoperative appointment I take out the “medications to avoid” sheet and review the importance with each and every patient.  Yet somehow two patients have arrived for surgery in the last month after taking medications that potentially could make them bleed.  In the interest of safety, both of these patients were cancelled and rescheduled.  They were upset and I understand this but so was I quite frankly.  Last minute cancellations on the day of surgery are upsetting for the patient.  They have taken off from work and their lives and schedules are rearranged.   They have gotten their minds and bodies prepared for surgery.  No cancellation is taken lightly.  I too have a schedule.  Certainly same day cancellations are an empty period of time that will never be replaced.  A 5 hour case that I cancelled this week is a big hole in the day that never can be used.   If she had a cold or was sick or there was a family emergency it would be one thing, but cancellations for reasons such as I didn’t take seriously the preoperative instructions are another thing.  This has happened with patients infrequently in the past, but a sudden increase in the numbers of patients doing this has made me rethink the importance of the topic.

What is the big deal?   What difference will one aspirin make?   Perhaps it will make no difference.  Perhaps the surgery will go as planned without complication.  On the other hand, perhaps she will bleed in the operating room or postoperatively due to the fact that the aspirin has stopped platelet function.  A significant bleed can lead to a huge number of consequences including more bruising, need for emergency surgery, need for transfusions, or even worse.

In cosmetic surgery the goal is to minimize risk.  Anything that can be controlled for and optimized should be optimized.

I have a new modified patient instruction sheet that I will now implement that now highlights and bolds the importance of these preoperative instructions and requires a patient signature acknowledging understanding.  Perhaps this will minimize these disappointing circumstances.  It is important to understand that cosmetic surgery is still surgery and minimizing risk and keeping patients safe is my responsibility.