Preoperative checklist: how to prepare for surgery, step by step

A preoperative checklist is a list of things to do and check before an operation (operasyon). "Pre-op" means "before surgery".

Your hospital team has its own checklist too. The World Health Organization (WHO) Surgical Safety Checklist has 19 items. The whole team stops at three moments (before you are put to sleep, before the first cut and before you leave the operating room) and checks each item out loud together. WHO says the checklist has lowered complications and deaths.

Your hospital's instructions always come first. If anything here differs from what your team told you, follow your team and ask them about it.

1. A few weeks before: go to your pre-op check-up and tests.
2. List everything you take, including vitamins and herbal products, and ask which medicines to keep taking.
3. Get as healthy as you can: stop smoking, tell your surgeon how much alcohol you drink, and keep blood pressure and blood sugar under control.
4. Sort out money and papers early: see PhilHealth and costs.
5. Sign the consent form only when you understand the operation, its risks and other choices.
6. Plan your trip home and who will stay with you (your bantay).
7. The day before: pack your bag and write down the exact time to stop eating and drinking.
8. On the day: follow the fasting rules, take only the medicines you were told to take, and arrive on time.
9. Tell your surgeon right away if you get a cough, cold, fever or other illness in the days before. The operation may need to be moved.

Before a planned operation, a doctor or nurse usually checks you, often within the month before. They look for problems that need treatment first. You may also meet the anesthesiologist, the doctor who puts you to sleep or numbs part of your body.

Common tests, depending on your age, health and operation:

• blood tests such as a CBC (complete blood count), and kidney, sugar and clotting tests
• urine test, chest X-ray and ECG (heart tracing)
• a pregnancy test for women who could be pregnant

Not everyone needs every test. UK guidance (NICE) advises against routine chest X-rays and urine dipstick tests for everyone. If you have diabetes, your HbA1c (average blood sugar over about 3 months) should be checked if it was not done in the last 3 months.

Bring all results to your surgeon; missing results delay operations. Your PhilHealth YAKAP clinic doctor can order lab tests in the YAKAP package, so ask whether your pre-op tests are covered. See our PhilHealth YAKAP guide.

Bring a complete list of what you take: name, how much and how often. Include medicines bought without a prescription, vitamins, herbal teas and capsules, and supplements.

Some can raise the risk of bleeding or cause other problems, and your doctor may ask you to stop or change them days to weeks before. Ask about:

• blood thinners, such as warfarin or clopidogrel
• pain relievers called NSAIDs, such as aspirin or ibuprofen
• vitamin E and herbal or food supplements
• diabetes medicines, such as insulin or metformin

Never stop a maintenance medicine on your own. Only your doctors can decide, and the plan differs for each person. Write down which medicines to stop, from what day, and which to take on the morning of surgery. If told to take one that morning, use only a small sip of water.

Also tell the team about allergies (to medicines, latex, tape or iodine) and any problem you or your relatives had with anesthesia.

• Stop smoking and vaping. Smoking slows healing and raises the risk of wound infection and blood clots. Stop at least 4 weeks before if you can; 10 weeks is even better. Nicotine gum is not encouraged around surgery, because nicotine still slows healing.
• Be honest about alcohol. Tell your surgeon how much you drink, especially if you drink every day.
• Control long-term illnesses. Surgery is safer when diabetes, high blood pressure and anemia are well controlled. If you use insulin, ask for an early morning schedule. See our guides on high blood pressure and types of diabetes.
• Stay active, as much as you safely can.
• Fix tooth problems first. Loose or decayed teeth can be damaged by the breathing tube, and after some operations, such as joint replacement or heart valve surgery, you may not be able to have dental work for 3 months.
• Ask about blood. If you may need a transfusion, ask how the hospital arranges it. Blood from a relative is not safer than volunteer blood.

NPO means "nothing by mouth". Your stomach must be empty so you do not vomit while under anesthesia.

• Follow your hospital's exact times for food and for drinks, and write them down. You may be told not to eat or drink anything after midnight. Some hospitals allow clear liquids, such as water, until a shorter time before, sometimes up to 2 hours before.
• Food includes light snacks and candy.
• Ask whether water is allowed, and until when. Don't fast longer than you are told.
• If you have diabetes, you still fast, but ask in advance what to do with your medicines and if your sugar goes low.
• In the morning you may brush your teeth, but spit out the water.

If you ate or drank by mistake, tell the staff before the operation. Don't hide it: they will decide whether it is safe to go ahead or whether to move the operation. If your child is fasting, don't eat or drink in front of them.

Before you leave home: bathe or shower (your surgeon may give you a special soap). Don't use deodorant, lotion, perfume or makeup. Remove nail polish, jewelry and piercings, and wear glasses instead of contact lenses. Wear loose clothes and flat shoes, and leave valuables at home. You may need to arrive up to 2 hours early.

Bring:

• a valid ID, plus your senior citizen or PWD ID if you have one (these discounts come off your bill first)
• your PhilHealth Member Data Record (MDR) or PhilHealth number, and your HMO or insurance card
• your admission letter or surgeon's orders, and all test results
• your medicines in their original packs, with your medicine list
• glasses (with their case) and any equipment you use, such as a cane, walker or CPAP machine
• clothes, toiletries, sanitary pads, a phone and charger for a hospital stay
• a notebook and pen, and some money

Make sure your bantay knows your medicine list, your allergies and your surgeon's name. Check the hospital's rules on watchers.

Ask for a cost estimate before a planned operation: what PhilHealth deducts, what your HMO covers, and what you may still pay.

How PhilHealth helps, as of November 2026:

• Case rates. For a covered operation in an accredited hospital, PhilHealth pays a fixed amount called a case rate. The hospital deducts it from your bill before you go home. It includes hospital charges and the doctors' fees.
• Day surgery, where you go home the same day, is also covered by case rates at accredited Ambulatory Surgical Clinics.
• Papers: your MDR or a PhilHealth Benefit Eligibility Form (PBEF), plus PhilHealth Claim Form 1.
• No co-payment in a ward bed. For admissions from January 2025, PhilHealth members in a basic or ward bed (a shared room with regular meals, an electric fan and a shared toilet) in accredited public and private hospitals should not pay extra for covered care. A private room, aircon or TV are extras you may pay for. If you are charged in a ward bed, ask for your itemized bill and give feedback to PhilHealth's Corporate Action Center.
• Higher case rates. A December 2024 circular raised selected case rates by 50% for admissions from January 2025, to lower what patients pay.
• Order of payment. Senior citizen and PWD discounts and PhilHealth come off the bill first. Your HMO, private insurance or company benefits then cover part of the rest.
• No 45-day limit. Since March 2025, PhilHealth no longer limits covered hospital days to 45 a year, as long as the care is medically needed.

For pre-op check-ups, your YAKAP clinic gives free consultations and covered lab tests. A private YAKAP clinic may charge up to ₱900 per patient for the whole year (PhilHealth YAKAP FAQs, July 2025).

Worried about the rest of the bill? Talk to the billing office or social worker early, and ask whether the hospital has a Malasakit Center for medical and financial help. See our guides to what PhilHealth covers and the Malasakit Center.

You sign a consent form for surgery and anesthesia, ideally well before the day. You can bring a family member, and you may change your mind any time before the operation.

Good questions to ask:

• Why do I need this operation, and what other choices do I have?
• What are the benefits and risks?
• Will I be asleep (general anesthesia) or numbed (regional or local)?
• How long will I stay, and when can I work, lift or drive?
• How will my pain be controlled?
• How much will it cost after PhilHealth?

Talk to our surgery preparation assistant to prepare your questions.

• You get an ID bracelet and are asked your name, birthday and operation many times. This is a routine safety check.
• The surgery site is marked, and an IV line is put into a vein.
• With a general anesthetic, you fall asleep within about a minute. The anesthesiologist stays with you the whole time, watching your heart, blood pressure and oxygen.
• In the recovery room, feeling sleepy, thirsty, cold or sick, or having a sore throat, is common and usually passes within hours.

Going home the same day: an adult must take you home. The effects of anesthesia can last about 24 hours, so for at least that long have someone with you, and don't drive, drink alcohol, care for children alone or make important decisions.

For a child's surgery, bring a favorite toy or blanket and expect the whole day to be busy.

Feeling nervous is normal. Ask your questions early, tell the team about your fears (such as needles), and arrange home, children and work beforehand. Slow breathing, prayer or music can help.

"Baka hindi na ako magising." (I might not wake up.) Serious problems from anesthesia are rare, and the anesthesiologist watches you closely throughout.

"Herbal ito, kaya okay lang." (It's herbal, so it's fine.) Some supplements can affect bleeding. List them and let the doctor decide.

"Itigil ko na lahat ng gamot." (I'll stop all my medicines to be safe.) Some medicines must be continued, even on the morning of surgery. Ask first.

Prayer and a blessing before an operation comfort many Filipino families. They go well with good preparation, including the fasting and medicine instructions.