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Welcome to Mount Sinai Spine.

We have made this booklet so that you and your family know what to expect throughout your surgery and recovery.

Everyone’s journey is different.

If you have questions, we are here to help.

Your

Surgical Preparation

Medication Instructions

• Medication to STOP Before Surgery

• Seven Days Before Surgery

• Three Days Before Surgery

• One Day Before Surgery

• Other Medications

• Vitamins and Supplements

• How Long Prior to a Procedure Should a GLP-1 Agonist Be Held?

Chlorhexidine Gluconate (CHG) Body Wipes

• Instructions for Using CHG Body Wipes for Spine Surgery Patients

• The Night Before Surgery

• The Morning of Surgery

One

•

Procedure

•

Your Surgeon and Hospital

Your surgery will take place at one of the following locations:

The Mount Sinai Hospital

1468 Madison Avenue, New York, NY 10029

212-241-6500 or 212-590-3300

Mount Sinai Morningside

1111 Amsterdam Avenue, New York, NY 10025

212-523-4000 or 212-857-9990

Mount Sinai West (Ambulatory Surgery entrance at 428 West 59th Street) 1000 10th Avenue, (between West 58th and West 59th Streets), New York, NY 10019

212-523-4000 or 212-857-9990

Mount Sinai Queens

25-10 30th Avenue (between 29th Street and Crescent Street), Astoria, NY 11102

718-932-1000 or 718-289-3100

Mount Sinai South Nassau

One Healthy Way, Oceanside, NY 11572

866-32-ORTHO or 866-326-7846

Peakpoint Midtown West Surgery Center

787 11th Avenue, Sixth Floor, New York, NY 10019

212-516-8204

Surgical Preparation

To make sure you are healthy enough to tolerate your surgery, you will undergo a preoperative medical assessment (POMA). Your POMA may include simple bloodwork or more complex testing, such as evaluations with specialists. Each patient receives a customized plan. We do this to ensure that you and your body are medically optimized for your procedure. Optimized patients have the best outcomes, fastest recoveries, and fewest complications.

Schedule a POMA with your primary care physician within 30 days of surgery.

Let your surgeon’s office of the contact information for the provider(s) completing your POMA.

Each patient receives a customized plan . We do this to ensure that you and your body are medically optimized for your procedure.

Medical clearance

• All test results and the POMA should be received at least two weeks prior to the surgical procedure.

• In some cases, you may be required to have an additional medical evaluation with a Mount Sinai anesthesiologist prior to your surgery. Contact your surgeon’s office to see if this is necessary for your procedure.

Prepare your home for your return

• Making simple changes to your home before surgery can make your recovery safer and easier.

• Move items that you use often from high or low shelves/cupboards to countertop areas.

• Minimize clutter on the floor to prevent tripping over objects and wires.

• Remove throw rugs and make sure electrical wires are well hidden.

Assistance at home after surgery

• You may need help from friends or family for a few weeks with tasks such as dressing, bathing, cooking, laundry, and pet care.

• If you qualify, a home health aide may be arranged by your social worker/care coordinator prior to your discharge from the hospital. Home health aides are also available for hire and are typically paid hourly.

Diabetic patients

• Please speak with your prescribing provider or endocrinologist prior to your procedure. You will need to discuss any necessary changes to your insulin regimen and/or oral medications.

Medication Instructions

Medication to STOP Before Surgery

The medications listed on pages six, seven and eight must be stopped prior to surgery in coordination with your prescribing provider and surgeon. Do not discontinue these medications without speaking to your prescribing provider.

Discuss the exact date to stop a medication with your surgeon and prescribing provider.

Failure to follow these instructions may result in your surgery being cancelled.

Seven Days Before Surgery

Blood thinners

Aspirin

Fondaparinux (Arixtra®)

Ticagrelor (Brilinta®)

Warfarin (Coumadin®)

Prasugrel (Effient®)

Apixaban (Eliquis®)

Enoxaparin (Lovenox®)

Clopidogrel (Plavix®)

Cilostazol (Pletal®)

Dabigatran (Pradaxa®)

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as:

Naproxen (Aleve®)

Celecoxib (Celebrex®)

Excedrin®

Indomethacin (Indocin®)

Meloxicam (Mobic®)

Three Days Before Surgery

Endoxaban (Savaysa®)

Ticlopidine (Ticlid®)

Pentoxifylline (Trental®)

Rivaroxaban (Xarelto®)

SGLT2 inhibitors:

Canagliflozin (Invokana®)

Dapagliflozin (Farxiga®)

Empagliflozin (Jardiance®)

Ertugliflozin (Steglatro®)

Ibuprofen (Motrin®, Advil®)

Diclofenac (Voltaren®)

› Medication Instructions (continued)

One Day Before Surgery

Blood Pressure Medications: Classified as an angiotensin receptor blocker (ARB), angiotensin receptor

neprilysin inhibitor (ARNI), or angiotensin converting enzyme inhibitor (ACEI), these medications must be stopped within 24 hours of your procedure. They can cause unsafe blood pressure during surgery.

Benazepril (Lotensin®)

Candesartan (Atacand®)

Captopril

Enalapril (Vasotec®, Epaned®)

Eprosartan (Teveten®)

Fosinopril

Irbesartan (Avapro®)

Lisinopril (Zestril®, Qbrelis®)

Losartan (Cozaar®)

Moexipril

Olmesartan (Benicar®)

Valsartan (Diovan®, Entresto®)

Other Medications

Telmisartan (Micardis®)

Quinapril

Ramipril (Altace®)

Perindopril

Trandolapril

Osteoporosis and Fracture Medications: Medications that help increase bone strength or slow down bone loss are commonly given to patients with osteoporosis and some types of spine injuries. Speak to your provider about when to stop taking these medications. Some common examples are:

Abaloparatide (Tymlos®)

Alendronate (Fosamax®)

Ibandronate (Boniva®)

Risedronate (Actonel®, Atelvia®)

Romosozumab (Evenity®)

Teriparatide (Forteo®, Bonsity®)

Vitamins and Supplements

If already prescribed, continue taking calcium, vitamin D, or magnesium.

Zoledronic acid (Reclast®, Zometa®)

Please STOP taking ALL other vitamins or supplements, including multivitamins and herbal supplements. If you are unsure of the guidance on a supplement you are taking, please call your surgeon’s office.

If you have taken any of these medications within seven days of surgery, call your surgeon’s office immediately.

Other Home Medications:

Contact your prescribing provider if you have any questions regarding your current prescription medications.

Medication Allergies:

Tell your surgeon as soon as possible if you are allergic to any medications.

› Medication Instructions (continued)

For Patients Taking GLP-1 Receptor Agonists

GLP-1 receptor agonists are widely prescribed to treat diabetes and to promote weight loss.

These medications slow down digestion and pose an increased risk of vomiting during surgery.

The medication should not be taken for a minimum of one dosing interval (eight days)

Patients with diabetes should consult their provider to manage their care without these medications during this time (for example, insulin dose adjustment).

How Long Prior to a Procedure Should a GLP-1 Receptor Agonist Be Held?

Brand

Ozempic �

Wegovy �

Rybelus �

Trulicity �

Saxenda �

Victoza �

Byetta �

Bydureon �

Adlyxin �

Mounjaro �

Zepbound

*Including day of procedure.

Semaglutide

Dulaglutide

Liraglutide

Exanetide

Lixisenatide

Tirzepatide

Chlorhexidine Gluconate (CHG) Wipes

You will receive two packets of CHG wipes from your surgeon’s office to apply the night before and the morning of your surgery. If you have not received them, please reach out to your surgeon’s office.

Instructions for Using CHG Wipes for Spine Surgery Patients

These instructions are for how to use antiseptic chlorhexidine gluconate wipes. Preparing your skin with CHG wipes helps prevent infections. You will apply the CHG treatment two times: once the night before the surgery, and once the morning of the surgery. Do not shave, wax, or remove body hair the day before of surgery or the morning of surgery. Keep the packages at room temperature.

The Night Before Surgery

Do not use powder, deodorant, or lotion.

1. Bathe or shower — wash your hair, face, and body with regular shampoo, conditioner, soap, etc.

2. Rinse off the regular shampoo, conditioner, and soap thoroughly.

3. Pat your skin dry with a clean towel.

4. Cover yourself with a towel or clean garment and wait 15 minutes.

5. Remove garment and apply CHG wipes to cool, dry skin as directed in the pictures below.

The Morning of Surgery

Do not use powder, deodorant, or lotion.

1. Bathe or shower — wash your hair, face, and body with regular shampoo, conditioner, soap, etc.

2. Apply CHG wipes to cool, dry skin as directed in the pictures below.

Use one wipe for your neck, chest, and abdomen.

Use one wipe for your right leg and foot, starting at the thigh and ending at the toes.

Use one wipe for both arms, starting with the shoulder (including underarm areas) and ending at the fingertips.

Use one wipe for your left leg and foot, starting at the thigh and ending at the toes.

Use one wipe for your right and left hip followed by your groin. Wipe folds in the abdominal and groin areas. Avoid the genitals.

Use one wipe for your back, starting at the base of your neck and ending at your waistline. Lastly, wipe the buttocks. Focus on the spine area. Ask for help if you can’t reach all areas

• Do not rinse after cleaning your skin with the CHG wipes. Allow area to air-dry for one minute. It is normal for your skin to feel “sticky” for several minutes. This will go away after your skin dries.

• Dress in clean clothes after your skin dries.

• Discard wipes in trash can; do not flush down toilet.

• Do not use powder, deodorant, or lotion.

› If you have any questions, please call your surgeon/surgery team.

One Day Before Surgery

Follow These Eating Instructions

Day before procedure:

• You may eat until 2 pm

• After 2 pm: ONLY clear liquids can be consumed (water, black coffee, or tea WITHOUT milk or cream, clear broth, carbonated beverages, clear fruit juice (free of pulp), clear electrolyte- and carbohydrate-containing beverages (for example, Pedialyte®, Gatorade®, Powerade®, etc. (not red), and JELL-O® (not red and without solid elements).

Day of the procedure, starting at MIDNIGHT:

• Strictly NOTHING BY MOUTH, except for sips of water for taking medications.

• Shower and apply your first packet of CHG wipes as stated in your patient education handout.

• Do not apply body lotions or deodorants the night before surgery.

• Pack an overnight bag for the hospital with only a few personal items.

• Bring a complete list of your current medications. Include dosages and time you take your medications.

• Do not bring valuables. Do not wear any jewelry.

• A representative will contact you the business day prior to your surgery to let you know what time to arrive for surgery.

• Typically, you will receive a call between noon and 3 pm

• If you do not receive a call by 3 pm, please reach out to your surgeon’s office.

Procedure Day Information

The morning of your procedure:

• Take the essential medications approved by your care team at Mount Sinai.

• Shower and apply your second packet of CHG wipes. Please wear clean, loose-fitting clothing.

• Do not apply body lotions or deodorants the morning of surgery.

Bring your packed bag with a list of your current medications, including dosage and how often you take them. If our pharmacy does not carry your prescribed medication, your inpatient team will provide an equivalent alternative.

Please arrive at the hospital at the instructed time. Proceed to the registration desk. You will be checked in and prepped for surgery. You will be instructed to change into a gown in the preop area.

While procedures are scheduled for a certain time, the time is an estimate. We appreciate your flexibility.

Preop Area:

• On the day of surgery, you will be asked to identify yourself and your planned surgery several times. This prevents errors and is required for all medical procedures across the country.

• You will meet with your surgical team prior to your procedure.

• Consent will be signed/reviewed by you and your surgeon.

• Your surgeon will mark your surgical site with their initials.

3M nasal swab:

*For Mount Sinai South Nassau patients only. Each patient will have a one-time therapeutic dose of an iodine-based medication to get rid of bacteria that may linger in the nose. This swab will be applied to both nostrils on the day of surgery. If you have an allergy to iodine, you will be prescribed an alternative (Bactroban®). Bactroban will need to be applied to both nostrils two times a day for five days prior to surgery.

Anesthesia

Before your operation, you will have the opportunity to meet with your anesthesiologist. They will discuss the specifics of the anesthesia and the medications they will use. You will receive general anesthesia.

After surgery, you will go to the Post-Anesthesia Care Unit, where you will be monitored closely. You will receive medications, if needed, to help with pain, nausea, and blood pressure if needed. Under certain circumstances, you may be placed in the Intensive Care Unit or another post-surgery unit after surgery. Ask your care team about which unit you will go to.

Once you are cleared by the recovery room team, you will either be discharged home or transferred to your room.

Hospital Stay

Patients may go home the same day as the operation depending on their health status. Your surgeon will decide whether you will be discharged the same day or if you need to stay in the hospital, which typically lasts one to five days.

Physical and occupational therapists will evaluate you and may teach you exercises to improve your strength and range of motion. This will become your personalized home exercise program. Our goal is for you to begin moving within 24 hours of your surgery.

You may also be seen and evaluated by a care coordinator and/or social worker to safely discharge you from the hospital. If you require discharge to a rehabilitation facility, the team will work on authorizing your insurance coverage and placing you in an appropriate location.

Clear communication helps us manage your pain effectively.

Pain Management During Hospital Stay

Managing pain is an important part of your recovery after surgery. Your care team will create a personalized pain management plan, which may include oral medications, intravenous medications, and/or a patient-controlled analgesia (PCA) pump, which you can use to self-deliver pain-relieving medication. As you recover, you will transition to oral pain medications.

Clear communication helps us manage your pain effectively. You will be asked to rate your pain on a scale from 0 (no pain) to 10 (worst pain). Please describe the type of pain (sharp, dull, burning, etc.) and report any changes or increases in pain.

Let your team know about any medication side effects, such as nausea, itching, dizziness, or constipation. Pain should decrease and your stamina should improve during your stay. By discharge, most patients need oral pain medication only.

Complication Prevention

Infection Prevention

Infections are a risk for all surgical procedures. Before and after your surgery, antibiotics are given intravenously. Let us know if you have any allergies or adverse reactions.

Lung Congestion Prevention

An incentive spirometer will be given to you after surgery to exercise your lungs. You should use it several times an hour to expand the small air sacs in your lungs, and help prevent pneumonia.

Constipation Prevention

As a result of anesthesia, pain medication, and reduced activity, you may experience constipation. Your surgeon will provide medications to help prevent and manage constipation. Increased dietary fiber, walking, and hydration can also reduce constipation. Reducing or pausing narcotic intake may assist in resolving constipation. If you are constipated for more than three days, despite taking these medications, please contact your surgeon’s office.

Nausea Prevention

You can request medication in the hospital to help alleviate postoperative nausea. When taking your pain medication, do so with food and a full glass of water to prevent nausea.

Discharge From the Hospital

It is best for you to recover at home and in a familiar environment. We have partnered with services that supply a physical therapist to come to your home based on your physician’s referral and can be set up with social work prior to discharge.

Postoperative Expectations

Following your surgery, you should expect to have some pain and muscle cramps/stiffness, which will gradually resolve over several weeks. Please call your surgeon’s office if you have any questions or concerns about your postoperative progress.

Dressing Care

You may have a dressing that consists of skin glue, sutures, staples, or adhesive tape. You will receive instructions on how to care for your incision in your discharge summary when leaving the hospital.

• DO NOT scrub the incision.

• DO NOT submerge the incision under water. Do not soak in a tub or pool until instructed by your surgeon.

Orthotic Devices

If you have been given an orthotic device, please follow the instructions that come with it, including regularly cleaning the device as indicated.

Wear your device until your surgeon tells you to discontinue. Whenever you remove the device, check your skin. Tell your surgeon’s office immediately if you experience signs of skin breakdown or infection.

Please contact your surgeon immediately if you experience any of the following symptoms:

• Saturated and/or leaking dressings

• Watery or colored drainage (pus) from the incision

• Growing redness on/around the wound

• Opening or separation of the wound

• Constant or severe pain that is worsening and not relieved by your medications

• Increasing numbness or weakness in your arm, hand, leg, or foot

• Temperature above 100.4 degrees Fahrenheit for two readings, four hours apart

• Problems with urinating or constipation

• Severe headache, especially when you go from lying down to standing or sitting

• You fall

Activity Restrictions

Your surgeon will specify the type of activity (driving, recreation, and returning to work) and restrictions you must follow. Instructions will be provided in your discharge summary when leaving the hospital.