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A woman is told that her gallbladder is inflamed and has to come out. A man has been waiting for a knee replacement, and the operation is scheduled for next week. Before either of these individuals shows up at the hospital for their operations, they and their doctors should take steps to avoid medical problems before, during and after an operation.

It’s the sort of prevention that takes time and effort, and surgical patients don’t always get the required attention. So if you’re heading for major surgery, here are a few things to inquire about.

First, ask your family doctor if you’re going to be started on a beta-blocker to prevent cardiac complications. Heart problems are the most common medical problem to arise after an operation. Between 2 per cent and 5 per cent of all patients having non-cardiac surgery will experience a heart problem.

To lower the risk, doctors prescribe beta-blockers — drugs that end in “olol” such as atenolol and metoprolol — several days or even weeks before surgery.

When a patient isn’t on a beta-blocker at the time of admission for surgery, the surgeon can order them in the hospital. Patients are supposed to remain on beta-blockers after the operation until they’re out of the danger zone. But a study published last February in the Archives of Internal Medicine found that only about one-third of patients who would have benefited from beta-blockers were on the drugs at the time of major surgery.

Blood clots are another significant postoperative problem that can be prevented. About 20 per cent of patients undergoing major surgery will develop a clot — known as a deep venous thrombosis or a venous thromboembolism — and 1 per cent to 2 per cent of patients will develop a clot in the lungs known as a pulmonary embolism.

To lower the risk, doctors are supposed to prescribe blood thinners such as heparin to keep the blood from clotting. But according to a report by the U.S. Agency for Healthcare Research and Quality, published last year, anticlotting medications are “often underused or used inappropriately” in surgical patients. Doctors may worry that patients on blood thinners will develop bleeding problems. Although the risk of bleeding is real, there’s a greater risk of developing — and dying from — a blood clot.

Delirium is another medical problem that happens after surgery. It’s frightening for the person going through it, and alarming for family members, because the patient doesn’t seem like himself. But it’s common. About one in 10 patients over age 50 gets delirious while recovering from surgery. The risk rises with age, and it’s particularly high in individuals undergoing surgery to repair a hip fracture. As well, delirious individuals are at risk for other problems, including pneumonia.

To avoid delirium, doctors try to avoid prescribing certain drugs. Some of the more common sleeping pills and pain medications can cause delirium, especially in patients over age 65. Another way to prevent the dangers of delirium is to detect it early. Family members are often better at that than doctors or nurses because they sense a change in a patient’s mental functioning a lot sooner.

Lowering your risk of problems with surgery requires planning ahead for patients as well as doctors. It’s a good idea to know the medications that you’re taking, with the exact dosages, before going to the hospital. Also, arrange a support team. Nurses often have so many patients assigned to them that they can’t always be there when patients need them. Having family members or close friends at the hospital is essential.

In fact, families sometimes hire a private nurse — a trained nurse’s aide — prior to a major operation. To find out how this works, talk to the charge nurse on the ward you’ll be admitted to after surgery. And once your team is in place, ask where they should wait while you’re in surgery, since large hospitals have multiple waiting rooms.

After the operation, you’ll be hooked up to things, likely a Foley catheter carrying your urine, and an intravenous line keeping you hydrated. Don’t ignore the lines. When a nurse comes by to hook something up to your IV pole, ask what it is. Last year, a woman in British Columbia kept herself from harm by preventing a drug error. A nurse was about to give her a toxic drug through her IV, and the woman objected because no doctor had told her she was supposed to receive it. The drug was intended for someone else.

Paying attention to that urinary catheter is also important. “Regrettably, unjustified and excessively prolonged catheter use persists despite clear evidence of its detrimental effects,” doctors from the University of Michigan wrote in the Annals of Internal Medicine in July, 2002. Urinary catheters are supposed to come out within 24 hours of surgery, but are often left in for several days. More than 80 per cent of urinary-tract infections are linked to the use of a urinary catheter. The longer it stays in, the greater the risk.

So one day after your operation, if you’re still attached to the catheter carrying your urine, ask when it will be removed.

In general, surgery is much safer than it used to be. But it could be safer still, if all the research findings about how to prevent surgical complications were put into practice.