Pre-op Screening

Complete this information once you are scheduled for surgery. This will help you prepare for your upcoming procedure! Please keep in mind that these are just guidelines based on the information you enter, at the Pre-op/Consent Visit your provider may have a different plan based on additional information or clinical experience.

"*" indicates required fields

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5%
Your Name*
Your Email*
Sex*
(for example for 5' 2", enter 5)
(for example for 5' 2", enter 2)
Since your BMI is 30-35, your pre-op diet will be 3 days in duration.
Since your BMI is 35-40, your pre-op diet will be 7 days in duration.
Since your BMI is 40-45, your pre-op diet will be 2 weeks in duration.
Since your BMI is 45-50, your pre-op diet will be 3 weeks in duration.
Since your BMI is over 50, your pre-op diet will be 4 weeks in duration.
Have you ever had a blood clot or pulmonary embolism (clot to lung) in the past?*
Have you ever been diagnosed with a clotting disorder, such as Factor V Leiden?*
Since you have a history of clotting in the past or have been diagnosed with a clotting disorder, post-op blood thinners will likely be required to reduce the risk of blood clots.
Since your BMI is over 50, post-op blood thinners will likely be required to reduce the risk of blood clots.
Do you currently take any ORAL birth control pills, or any medication containing estrogen?*
In order to reduce the risk of blood clots, all ORAL birth control pills and/or any medication containing estrogen need to be held for 4 weeks prior to surgery and not resumed until 4 weeks after. During this time it is important to use a barrier method of birth control!
If you have less than 4 weeks until your surgery and have not stopped estrogen, please text or call us at (513) 572-1718 for alternative arrangements as soon as possible.
Do you use any medications for erectile dysfunction such as Viagra (silfenafil), Cialis (tadalafil) or Edex (alprostadil)?*
ED medications such as these need to be stopped 72 hours prior to surgery and held for one week after.
Are you a diabetic?*
At your Pre-op/Consent Visit, your provider will discuss adjusting your diabetes medications when you start your pre-op diet. After that visit, please notify your prescribing physician of the proposed changes to your regimen.
Do you currently take any of the following medications for diabetes or weight loss?*
Long-acting GLP-1 medications such as these must be stopped at least 2 weeks prior to surgery. If you are taking these medications for diabetes, please contact your prescribing physician and let them know. If you are taking them for weight loss, you can just stop them.
Do you take any of the blood thinners listed below?*
Aspirin and other blood thinners will usually need to be stopped prior to surgery! A plan will be discussed at your Pre-op/Consent Visit.
Do you take any of the non-steroidal anti-inflammatories (NSAID's) listed below?*
NSAID's need to be stopped completely starting 7 days prior to surgery. Gastric bypass patients should never resume NSAID's. All other procedures can resume NSAID's after 4 weeks.
Do you take any ACE inhibitors or angiotensin II receptor blockers for high blood pressure? These are medications that end in "pril" or "artan."*
ACE inhibitors and angiotensin II receptor blockers need to be held for 24 hours prior to surgery, and also held the day of surgery. They can be resumed the morning after your procedure.
Do you take any diuretics (water pills) for high blood pressure or swelling? (Or any combo med that contains one of these)*
Diuretics (water pills) should be held on the morning of surgery, and then not taken for the following week in order to prevent dehydration.
Are you currently on any oral steroids such as prednisone, prednisoline, methylprednisolone?*
Oral steroids need to be stopped for 4 weeks prior to surgery. Bypass patients should NOT resume steroids ever. All other procedures can resume them if necessary after 4 weeks.
Do you take any other non-steroidal immunosuppressants?*
Non-steroidal immunosuppressants generally need to be held for a period of time before (and after) surgery. Please discuss a plan with your provider at the Pre-op/Consent Visit.
Have you or any of your blood relatives experienced a condition known as "malignant hyperthermia" after general anesthesia?
Special precautions need to be taken for patients who have a personal or family history of malignant hyperthermia. Please call or text us at (513) 572-1718 as soon as possible and let us know about this issue!
Do you have a responsible adult to drive you home (or to the hotel) and stay with you for the first 24 hours after surgery?*
You must have a responsible adult to drive you home (or to the hotel) and stay with you for the first 24 hours after surgery. If you show up without somebody, we will have to cancel your procedure. Ridesharing such as Lyft and Uber are not allowed. If you don't have anyone, there is a service called Home Helpers that you can hire.
Where is your surgery scheduled?*
How far are you from JourneyLite Surgery Center by car? (10475 Reading Road, Cincinnati, OH 45241)
Since you live less than an hour away, you will be able to go home after a minimum of 4 hours of observation after your procedure.
Since you live 1-3 hours away, you will be discharged to the Wingate Inn after a minimum of 4 hours of observation after your procedure. You will be required to stay overnight and can return home the following morning.
Since you live 3+ hours away, you will be discharged to the Wingate Inn after a minimum of 4 hours of observation after your procedure. You will be required to stay 2 nights and then be seen in our main office (in the same building as the surgery center) prior to heading home.
Due to last-minute cancellations and reschedules, we cannot set the order of cases until 1 business day prior to your actual date of surgery. You will be notified of your exact arrival time either by text or by phone call the afternoon prior to your procedure.
Arrival time notification*
Do you use a CPAP machine?
Please bring your CPAP machine with you to JourneyLite as you will need it during the recovery phase!
Thank you for completing your pre-op screening form. We will review the information and contact you if we have any questions.
Consent*
The information provided in this form will be transmitted by email to JourneyLite Physicians/JourneyLite Surgery Center.
This field is for validation purposes and should be left unchanged.
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