Exceptions may be made for below requirements in individual scenarios (based on surgeon approval)

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•    Hemoglobin A1c <8.0  (this goal may be higher in elderly/ fragile patients)

•    SBPs<160s  DBP<100

•    Stable kidney disease (unchanged creatinine over 6 months)

•    Stable cardiopulmonary disease (no new dyspnea, cough, worsening exercise tolerance, weight      gain, edema, angina, syncope, brady- or tachyarrythmias…etc)

•    No recent fever or infections (pneumonia, UTI, URI, cellulitis…etc.)

•    BMI<40

•    Sobriety from EtOH and illicit substances > 6 months

•    Tobacco cessation > 4 weeks

•    Social supports and stable housing  

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Illicit substances & Tobacco (heroin, non-prescribed opiates or benzodiazepines, methamphetamine, cocaine, excessive alcohol…etc.)    Use of illicit substances can make surgery and general anesthesia deadly.  Patients using these must be sober and clean for 6 months prior to surgery and have random monthly screening tests through PCP prior to surgery.

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We ask that patients stop smoking at least 4 WEEKS prior to surgery.  Please reiterate the association of smoking with delayed wound healing, worse surgical outcomes and increased complications.  Because most our procedures are elective, this is a unique opportunity for patients to make the commitment to stop smoking.  We are happy to assist with finding local resources to achieve this.