Pre-Surgery FAQs

Fasting before surgery: when to stop eating and drinking

These are the questions people ask us most in the last day or two before their operation, from fasting and nail polish to what to bring. They cover the night before and the morning of your day-case surgery; for the weeks before, see preparing for cosmetic surgery. Your patient coordinator confirms your arrival time and fasting times in the days before your operation, and your information pack has the details for you: if anything here differs from your own instructions, follow your instructions.

The usual rules at our hospital are:

• No food for at least six hours before your admission time. That includes milk, sweets and chewing gum.
• Clear fluids until two hours before your admission time: still water, or black tea or coffee.
• Nothing at all after that, apart from your regular medicines with a small sip of water if you have been told to take them.

These timings follow European anaesthetic guidance, which encourages clear fluids up to two hours before planned surgery and stopping solid food six hours before^[1]. Enter your admission time to work out your own cut-off times:

Why can’t you eat before surgery?

Anaesthesia and sedation relax the reflexes that normally stop food or liquid from your stomach going down into your lungs. An empty stomach makes that very unlikely, which is why you fast, whether you are having TIVA (total intravenous anaesthesia) or local anaesthetic with sedation.

Fasting for longer than you need does not make you safer. A Cochrane review of 22 trials found that a shorter fast for clear fluids did not increase the risk of stomach contents coming up, compared with fasting from midnight, and that people who drank water beforehand had less in their stomachs^[2]. Being well hydrated also helps you feel better afterwards: in a study of 11,500 day-surgery patients in the European Journal of Anaesthesiology, allowing clear fluids closer to surgery cut sickness after the operation from 5.2% to 3.8%^[3]. So drink clear fluids up to your cut-off time, then stop.

Can you drink water before surgery?

Yes, until two hours before your admission time, unless your instructions say otherwise. Plain still water is ideal. If you have a sip of water after your cut-off by mistake, do not worry and do not hide it: tell your nurse when you arrive. A small sip is unlikely to be a problem, but your anaesthetist needs to know and may adjust the timing of your operation.

The night before surgery

• Eat a normal meal in the evening, before your food cut-off.
• No alcohol, and no smoking or vaping: you should already have stopped all nicotine four weeks ago.
• Shower or bath the night before or on the morning of surgery, with your usual soap, and wash your hair.
• Do not shave the area being operated on. If any hair needs removing, the team will take care of it on the day. A Cochrane review of hair removal before surgery found that shaving with a razor led to more wound infections than not removing hair, or using clippers^[4].
• Take off nail polish, and gel or acrylic nails, and remove jewellery and piercings, unless your instructions say otherwise. The NHS gives the same advice before any operation^[5].
• Pack your bag (see the checklist below), set alarms for your fasting cut-offs, and get an early night.

Can you wear nail polish during surgery?

Take it off if you can. During your operation, a small clip on your finger measures the oxygen in your blood through your nail, and the team also looks at the colour of your nail beds. Dark polish can affect the reading slightly: in a study in the journal Resuscitation, black, purple and dark blue polish changed oxygen readings the most, although all colours stayed within the monitors’ normal margin of error^[6]. Removing polish, and gel or acrylic nails, simply makes monitoring as accurate as possible. If you cannot remove them, tell your nurse when you arrive.

The morning of surgery

• Follow your fasting times and take only the medicines you have been told to take, with a sip of water.
• Brush your teeth if you like, but do not swallow the water.
• Skip make-up, moisturiser, body lotion, fake tan and perfume, unless your instructions say otherwise. Your skin needs to be clean for the surgeon’s markings and dressings.
• Wear glasses rather than contact lenses. If you must wear lenses, bring their case.
• Wear loose, comfortable clothes: a top that opens at the front, soft trousers and slip-on shoes, so you can dress easily over your dressings or garment.
• If you have your period, you can still have surgery. Tell your nurse when you arrive.
• If you wake up unwell, with a cold, fever, cough or stomach upset, call us as early as possible on 020 7993 4849. We will assess you case by case and, if it is safer, move your operation. Read what happens if you have a cold before surgery.

What to take to hospital for day surgery

Keep it light: you will be going home, or back to your hotel, the same day. Tick off each item as you pack.

If your prescribed medicines are not collected yet, you can collect them before surgery or your companion can collect them while you are on the ward.

What happens when you arrive at the hospital

Arrive at the time your coordinator gives you, usually about an hour before your operation, so there is time to complete your paperwork, including your consent form. Read it carefully and ask about anything you are unsure of. Expect to be with us for four to six hours from arrival to going home.

• A friend or family member can come with you and wait until you are admitted. After that they leave, keep their phone on and stay within a 20 to 30 minute journey of the hospital for the rest of the day.
• On the day ward you change into a gown, a head cover, disposable underwear and foot covers, in your own private bay.
• Your nurse checks your blood pressure, pulse and details, confirms your procedure and gives you an identity wristband.
• Your anaesthetist asks some final questions and explains your anaesthetic.
• Your surgeon sees you for a final check, answers any last questions and marks your skin.

You will usually spend 45 to 60 minutes on the ward before your operation, sometimes longer if an earlier operation takes more time. Your patient journey sets out the whole process from consultation to aftercare.

Going home after surgery

Almost all our operations are day cases. When you are ready, your nurse goes through your aftercare instructions with you and your responsible adult, who takes you home by car or taxi and stays with you for the first 24 hours. We cannot discharge you without one. We combine TIVA with local anaesthetic, and our regular pain audits show this keeps the need for strong opioid painkillers to a minimum, even after larger operations. If you are travelling from further away, see travelling to us for surgery; for the days and weeks that follow, see recovery after cosmetic surgery and our questions after surgery.

People often worry about getting the morning wrong. You will not: drink your water up to your cut-off, come in comfortable clothes, and tell us about anything you are unsure of when you arrive. The team will take it from there.

Dr Spyridon Vlachos, Specialist Plastic Surgeon and medical reviewer

References

Guidance comes from the official sources listed.

1. Smith I, Kranke P, Murat I, et al. Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2011;28(8):556–569. doi:10.1097/EJA.0b013e3283495ba1
2. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003;(4):CD004423. doi:10.1002/14651858.CD004423
3. McCracken GC, Montgomery J. Postoperative nausea and vomiting after unrestricted clear fluids before day surgery: a retrospective analysis. Eur J Anaesthesiol. 2018;35(5):337–342. doi:10.1097/EJA.0000000000000760
4. Tanner J, Melen K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2021;8(8):CD004122. doi:10.1002/14651858.CD004122.pub5
5. NHS. Having an operation (surgery): before surgery.
6. Hinkelbein J, Genzwuerker HV, Sogl R, Fiedler F. Effect of nail polish on oxygen saturation determined by pulse oximetry in critically ill patients. Resuscitation. 2007;72(1):82–91. doi:10.1016/j.resuscitation.2006.06.024