Surgery has a process.
Know it before you're in it.

The six stages of surgery

Each stage has a job, a time frame and things to finish before the next. Each box opens the guide for that stage.

Part of a clinic or surgery center team? See MSKValue for musculoskeletal program tools.

What to Expect: Your Surgery Timeline

Understanding the timeline helps reduce anxiety and ensures nothing falls through the cracks. Here is what to expect at each stage.

Build Your Question List

Pick your surgery type and what worries you. You get a list of questions to bring to your pre-op visit, based on AHRQ, AAOS and American College of Surgeons guidance.

Prehab: Preparing Your Body

Going into surgery stronger tends to make the early weeks easier. The trial evidence on formal "prehab" is mixed and varies by procedure and starting fitness — but arriving fitter, especially if you're out of shape, is low-risk and something you control.

Medication Management

Proper medication management before surgery is critical for safety. Here is what you need to know.

Medications Typically Stopped Before Surgery

• Warfarin -- stopped days ahead, commonly about 5 days before, on the exact plan your prescriber and surgeon give you (ACCP perioperative antithrombotic guideline, Chest 2022)
• Eliquis (apixaban) or Xarelto (rivaroxaban) -- a shorter stop, often 1 to 2 days before, depending on the operation's bleeding risk, on the plan your prescriber gives you (PAUSE study, JAMA Intern Med 2019; ACCP perioperative antithrombotic guideline, Chest 2022)
• Aspirin -- a separate decision: if you take it for your heart, a stent or a past stroke, do not stop it on your own; your prescriber and surgeon decide together whether you keep taking it (POISE-2 trial, N Engl J Med 2014)
• Anti-inflammatory drugs (ibuprofen, naproxen) -- ask your team whether and when to stop them
• Supplements (fish oil, vitamin E, garlic, ginkgo biloba) -- supplements can interact with medicines or pose risks before surgery, so tell the team about each one (NIH NCCIH)
• Diabetes medicines (metformin, insulin and others) -- ask the team for the plan for the day before and the morning of surgery
• GLP-1 medicines (Ozempic, Wegovy, Mounjaro, Zepbound) -- the anesthesia team asks about these because they can slow how fast the stomach empties; they tell you whether to hold a dose (American Society of Anesthesiologists, 2023)

Medications Typically Continued

• Blood pressure medications -- usually taken the morning of surgery with a sip of water
• Heart medications -- almost always continued
• Thyroid medications -- taken as usual
• Anti-anxiety medications -- discuss with your surgeon and anesthesiologist

Important: Never stop or start any medication without your surgeon's explicit guidance. Bring a complete list of all medications, supplements, and dosages to every pre-operative appointment. Make the list here; it marks the ones the team asks about.

Mental Preparation

Going in with clear expectations helps you feel calmer before surgery. A review of trials of formal pre-operative education before hip or knee replacement could not say whether it reduces anxiety, pain or recovery time beyond usual care (Cochrane review, 2014) — its real value is knowing the steps ahead, asking the right questions, and having your home and support ready.

Strategies That Help

• Understand the procedure. Ask your surgeon to walk you through what will happen. Knowing reduces fear of the unknown.
• Set realistic expectations. Recovery is not linear. There will be good days and setbacks. This is normal.
• Build your support network. Identify who will help you in the first 1-2 weeks. Accept the help.
• Practice relaxation techniques. Deep breathing, guided imagery, or meditation can reduce pre-surgical anxiety.
• Write down your concerns. Putting worries on paper and discussing them with your surgeon makes them manageable.
• Plan your recovery activities. Books, podcasts, shows, puzzles -- having things to do prevents the restlessness that leads to doing too much too soon.

What to Bring to the Hospital

When you have read the guide above, check what you know: eight questions, each keyed to a line on this page.

Check what you know

The readiness assessment asks whether you have things in place. This asks what you know. Eight questions, each keyed to a line on this page; a wrong tap shows the line and where to re-read it. Your taps never leave your phone.

It measures what this page explained, not how prepared you are for your operation. For that, use the readiness assessment, the visit rehearsal and your surgical team.

1. 1You take a blood thinner such as warfarin, Eliquis or Xarelto. When does this page say you stop it before surgery?

   Two weeks before, on your own, to be safeWhen your prescriber and surgeon tell you: the timing depends on the drug (warfarin days ahead, Eliquis or Xarelto often 1 to 2 days)Never: blood thinners are always continued

   Each blood thinner has its own timing: warfarin is commonly stopped about 5 days before, Eliquis or Xarelto often 1 to 2 days before, and aspirin taken for the heart is a separate decision. Your prescriber and surgeon give the exact plan. Never stop or start any medication without your surgeon's explicit guidance, and bring a complete list of medications, supplements and doses to every pre-operative appointment. Re-read: Medication management

2. 2Which of these does this page list among supplements usually stopped 7–14 days before surgery?

   Thyroid medicationBlood pressure medicationFish oil, vitamin E, garlic and ginkgo biloba

   Supplements (fish oil, vitamin E, garlic, ginkgo biloba) are usually stopped 7–14 days before. Thyroid medication is taken as usual and heart medications are almost always continued. Your surgeon confirms each one. Re-read: Medication management

3. 3If you smoke, how far ahead of surgery does this page say stopping helps?

   The night before is enoughEven 4–6 weeks before reduces wound complications and infection riskStopping makes no difference to healing

   If you smoke, stopping at least 4 weeks before surgery lowers wound-healing problems and other complications after surgery. Talk to your doctor about cessation aids. Re-read: Prehab: preparing your bodySource: Mills 2011 (meta-analysis, Am J Med)

4. 4What does this page say about the trial evidence on formal prehab?

   It is mixed and varies by procedure and starting fitness; arriving fitter is low-risk and in your controlIt proves prehab halves recovery timeIt shows exercise before surgery is risky

   The trial evidence on formal prehab is mixed and varies by procedure and starting fitness, but arriving fitter, especially if you are out of shape, is low-risk and something you control. Re-read: Prehab: preparing your body

5. 5About how much protein a day does this page suggest before surgery, unless your care team advises otherwise?

   Less than usual, to rest the gutAbout 0.3 g per kg of body weightAt least 1.2 g per kg of body weight (roughly 0.55 g per pound)

   Increase protein to at least 1.2 g per kg of body weight daily (roughly 0.55 g per pound) unless your care team advises otherwise, with enough vitamin C, vitamin D and zinc. Re-read: Prehab: preparing your body

6. 6On the day of surgery, how early does this page say you usually arrive?

   Right at the scheduled start timeUsually 1–2 hours before the procedureThe evening before

   Arrive at the designated time, usually 1–2 hours before the procedure, with your ID, insurance card and paperwork. The team reviews the procedure, marks the surgical site and answers final questions. Re-read: Your surgery timeline

7. 7Why does this page want the person helping you to hear the discharge instructions with you?

   As the anesthesia wears off you may not remember the details clearlyThe hospital needs their signatureSo you do not have to ask any questions yourself

   Have your caregiver present to hear instructions alongside you; you may not remember details clearly. The team reviews discharge instructions, pain management, wound care and follow-up timing. Re-read: Your surgery timeline

8. 8Contact lenses on the day of surgery: what does this page say?

   Wear them so you can see the teamLeave them at home and wear glassesKeep them in a pocket for afterwards

   Leave at home: jewelry and watches, contact lenses (wear glasses), valuables and large amounts of cash. Dentures and hearing aids: discuss them with your team. Re-read: What to bring