St. Joseph’s Health Centre’s Surgical Program is a leader in its field, providing high quality care to meet the diverse surgical needs of our catchment area and the wider community.
As a university-affiliated program, the Surgical Program offers a range of care and procedures from thoracic and general surgery to gynaecology, ophthalmology and urology. Patients from infancy to the elderly are cared for by our exceptional team of surgeons, anaesthetists, health professionals and support staff. Our program has ten operating rooms and three inpatient units.
Our focus on minimally invasive surgery (MIS) has resulted in our program being a recognized national leader in this evolving field. Gynecology and general surgery are two areas where the program is an acknowledged leader. St. Joseph’s Health Centre is the first choice of University of Toronto surgical residents.
The Division of General Surgery at St. Joseph’s involves a clinically diverse and active group of surgeons. Our general surgeons specialize in removing cancerous tumors of the breast, liver, pancreas, gastrointestinal tract, colon and rectum. In addition, a wide spectrum of benign surgical conditions are treated, including inguinal and ventral hernia repairs, gall bladder surgeries and appendectomies. Our hepatobiliary (HPB) and bariatric programs are designated level 1 programs within the province. An acute care service (ACS) is designed to streamline care efficiently to sick patients in need of timely surgical intervention. Our surgeons provide modern, comprehensive care for routine problems and for critically ill patients. St. Joseph’s general surgeons offer a collaborative approach to patient care, working closely with colleagues in other surgical and medical specialties to find the best treatment approach for each patient.
St. Joseph’s orthopedic surgeons are recognized both locally and nationally for their surgical technical excellence and breadth of skill set. In addition to providing outstanding care to patients requiring hip and knee arthroplasty procedures, our surgeons also include subspecialty expertise in shoulder surgery (including arthroscopic repair and total shoulder replacement surgery), knee surgery (including arthroscopic ACL knee repairs) and foot and ankle surgery. Together with an experienced core of physiotherapists and rehabilitation specialists the orthopedic needs of Toronto’s west end community are met by our orthopedic surgery service.
Hip and knee replacement surgery recovery
You have an important role in your recovery after your total joint replacement. You will see a physiotherapist at the hospital after your surgery to teach you exercises and how to move. Learn more about your rehabilitation options.
St. Joseph’s thoracic surgery service has been designated a level 1 priority program by the provincial Ministry of Health. This group of surgical specialists diagnose and treat diseases of the chest including lung and esophageal cancer. In addition to malignancy this surgery service also has a regional expertise in the surgical management of gastroesophageal reflux disease, hyperhidrosis and congenital chest wall deformities. Every year, our thoracic surgeons perform many complex chest procedures using the latest technology and innovative methods. Integrated treatment teams include the participation of pulmonologists, radiologists trained in specialized diagnostic and therapeutic procedures along with respiratory therapists and outstanding perioperative nursing care.
Our ophthalmology service provides outstanding care for patients in our community requiring cataract extraction surgery. In addition to this vital service there is also sub-speciality clinical expertise in glaucoma, strabismus surgery and uveitis (ocular inflammation) care.
Specialists in the Department of Otorhinolaryngology (ear, nose and throat or ENT) at St. Joseph’s Health Centre evaluate and treat patients with problems of the ear, nose, sinus, and head and neck region. ENT specialists develop a customized treatment plan for each patient after a thorough evaluation using the latest diagnostic technology. Conditions treated and areas of clinical expertise include thyroid cancer, sinus surgery, nasal septal surgery, tonsillectomies/adenoidectomies and tympanostomy tube insertions.
Specialists in the Division of Urology at St. Joseph’s provide consultation, diagnosis and treatment for cancerous (malignant) and noncancerous (benign) diseases of the urinary tract, including prostate, kidney and bladder cancer; urinary incontinence; benign prostatic hyperplasia and kidney stones. Our urologists offer compassionate, state-of-the-art care for people of all ages. Urologists at St. Joseph’s have special expertise in minimally invasive (laparoscopic) surgery that results in less discomfort and bleeding and a faster recovery than conventional surgery.
The Division of Plastic Surgery at St. Joseph’s offers comprehensive care in all forms of plastic and reconstructive surgery. Areas of interest and expertise include tendon and nerve repair, aesthetic surgery, breast reconstructive surgery and reconstructive procedures of the ear.
Anesthesia and Acute Pain Services (APS)
Our Acute Pain Service (APS) is a team of anesthetists and a nurse practitioner that are available for inpatient consultation, as requested by the surgical or medical team, 24 hours a day, 7 days a week. APS provides acute pain management to post-operative and complex pain management patients by a variety of methods including Patient Controlled Analgesia (PCA), epidural analgesia and peripheral nerve block. APS is also available to manage acute pain in non-surgical patients on request. APS works in conjunction with other services including Addictions Management and Palliative Care Services where the patient may benefit from an interdisciplinary approach to improve function and quality of life. Each patient consulted to APS will be assessed daily or as deemed appropriate by a member of the APS.
For more inforation, see the Pain Management and Anesthesia page.
Our pre-admission clinic offers the following services:
- Nursing assessment: will review your health history and provide teaching about what to expect for your surgery.
- Anesthesiologist: will obtain a medical history, examine you, and then discuss the anesthesia options for your surgery.
- Internal medicine physician: will review your medical history.
- Pharmacist: will complete a pharmacological assessment.
- Blood Conservation Coordinator: will review your health history and help you create a plan for your blood management.
- Occupational therapist: will do a total joint assessment and teaching prior to your surgery.
I am booked for my surgery – what happens next?
Your surgeon’s office will give you a package of forms
- Complete the “Patient Self-Assessment” form while you are in your surgeon’s office.
- The “History and Physical” form must be completed by your family doctor, so be sure to make an appointment for this well in advance of your surgery date.
- If you are having a knee or hip replacement, follow the instructions to attend a group class where you will learn exercises for before and after your surgery.
We will review the information that is sent from your surgeon’s office to determine if you need an appointment in our pre-admission clinic. You may be called in for an appointment and/or be called by our pre-admission nurse.
What happens if I am asked to come in for a pre-admission clinic appointment?
- See Patient Instruction Sheet – Pre-Admission
- We will try to schedule the visit for a time that is good for you.
- Patients who have limited mobility, are confused or do not speak English should bring a family member with them to provide assistance.
- You do not need to fast from food or drink for this appointment, only on your surgery date.
- Take your usual medications as prescribed on the day of your pre-admission appointment.
- You may have a blood sample taken and/or ECG (echocardiogram)
Please bring to your pre-admission appointment:
- Your Ontario Health Insurance Plan (OHIP) card and/or any information on your semi-private/private insurance coverage.
- All of your medications that you take including any herbal supplements.
- A current up–to-date list of your medications.
- Numbers for your pharmacy, family doctor and specialist doctors.
- Any tests/lab results that you may have (e.g. stress tests, sleep studies, ultrasounds, X-rays, MRIs, CT-scans).
- CPAP machine settings and/or pacemaker card (if applicable)
- A book or magazine to read while you wait for tests.
Important medical issues to discuss with the anesthesiologist
There are several medical issues that may affect the type of anesthesia you receive for your surgery and are important for your anesthesiologist to know about and plan for with you. These include:
1. History of difficult intubation
2. History of serious anesthetic reactions (malignant hyperthermia or pseudocholinesterase deficiency)
3. Obstructive sleep apnea
5. Allergies (antibiotics, local anesthetics, latex)
6. Chronic pain
7. Severe post-operative nausea and vomiting
If you have any questions, please ask. Getting information will help you to make informed healthcare decisions. For more information, please contact the Pre-Admission Centre at 416-530-6504.
It’s the day before my surgery. How should I prepare?
- Patient Instructions On The Day Of Your Surgery
Please make arrangements for transportation. A responsible adult must pick you up and take you home after surgery. Failure to comply with these instructions will result in your surgery being cancelled.
What should I do if I need to cancel my surgery or it has been delayed to another date?
- If you have to cancel your surgery, contact your surgeon’s office immediately. This will allow someone else to have that valuable operating room time and your surgery will be rescheduled.
- We often request that you stop certain medications for several days before an operation, particularly blood thinners. If your surgery is delayed or postponed, it is important to get directions to guide you with respect to your medications. Because every patient’s situation is different, an anesthesiologist will have to review your particular situation and instruct you on the medications that will need to be restarted. It is best to phone the Pre-Admission Clinic at 416-530-6000 ext. 4144 and a member of our team will review your chart and assist you.
Day of surgery registration
All surgical patients begin their day here. Some patients will return to this location later the same day to be discharged. Those being admitted for an overnight stay will go to an inpatient unit.
- Please register at Day of Surgery on the second floor of our Barnicke wing.
- Be sure to bring your Ontario Health Insurance Plan (OHIP) card and photo ID with you.
- Bring information on your semi-private/private insurance coverage.
- If you will be staying overnight in the hospital, the pharmacist will review all your current medications that you are taking.
- Please be sure to bring to the hospital your medications in the pill bottles, including herbals and supplements.
- The pharmacist will let you know when you should send your medications back home.
What can I expect on the day of my surgery?
When you arrive, the day of surgery staff will:
- Give you one bag for your clothes. The bag will be given back to you after your surgery.
- We are not responsible for valuables, so please leave them at home. If you need extra belongings for your stay, please have a family member bring them to your room after surgery.
- Help you change into a patient gown (please come wearing loose-fitting, comfortable clothes).
- Ask you to remove any dentures, eye glasses and hearing aids and give them to your family member for safekeeping. If you are alone, we will label them and put them in the bag with your clothes.
- Please note: for safety reasons, you must remove all jewelry before you come to the hospital. This includes ALL piercings, tight-fitting rings and bracelets. Your surgery could otherwise be cancelled.
- Confirm the information from your completed self-assessment form and/or pre-admission clinic appointment.
- Take your heart rate, breathing rate, blood pressure and temperature.
- Just before you go into the operating room, the nurse or anesthesiologist may start an intravenous (IV) line to give you fluids and medication before your surgery.
- Your anesthesiologist will meet with you to:
- Confirm what type of anesthesia you will have.
- Review your medications, lab results and any new specialist reports you may have.
- Discuss your pain management plan after surgery.
- Answer any questions that you might have about your anesthetic plan.
- Please note, day of surgery is not a suitable area for children
- We ask that only one family member join you while you are in the day surgery department.
- During surgery, families are asked to wait in the family waiting room where the surgeon will come speak to them once the procedure is completed if applicable.
What happens after my surgery?
What if I am expected to go home right after surgery?
- You will return back to the day of surgery area to recover before you go home.
- After surgery, you may feel a little shaky or sleepy until the effects of the anaesthetic wears off.
For the 24 hours following surgery, you must:
- Be in the care of a another adult
- Not drive a motorized vehicle or operate hazardous machinery
- Hold off on any important decisions
- Not travel alone by public transit
- Not consume alcohol
- Not drive; a responsible adult must pick you up and take you home after surgery.
Failure to comply with these instructions will result in your surgery being cancelled.
What if I am staying overnight at the hospital?
- Once you leave the operating room, you will be transferred to the recovery room.
- When you are awake you will be transferred to an inpatient unit.
- Your family will meet you in your room and they are allowed to remain with you and visit you throughout your stay.
- Your inpatient surgical team will consist of:
- Your surgeon
- Members of the pain service team
- Nurses, occupational therapists, physiotherapists/rehab assistants
- Pharmacists, dietician, social worker, speech-language pathologists
- Health care attendants and unit clerks
What do I need to have during my hospital stay?
Please note: The hospital is not responsible for personal property brought onto the premises.
We encourage you to bring your own personal care items such as:
- shaving kits
- sanitary pads/incontinence products and tissues.
- Nightgown/pyjamas or comfortable clothing
- A pair of non-slip shoes (we do not recommend slippers)
- A good book, magazines, or newspaper
Most items can be purchased at the hospital gift shop.
If you have valuables with you (cash, credit cards, jewlery, etc.), please ask a relative or friend to take them home for you.
What happens when it's time to go home?
Discharge time is 10:00 a.m.
- Please ensure you arrange for someone to pick you up from the hospital.
- If your ride home is delayed you may be asked to wait in the patient lounge.
- The person picking you up should come to your room to help you with your personal items.
- Arrangements can be made for someone to assist you.
Please ensure you have all your belongings, your aftercare instructions, prescriptions and follow-up appointments arranged.
- Cast Care
- Crutch Walking
- Deep Breathing & Coughing Exercises
- Fracture Hip Exercises
- Total Hip Arthoplasty Exercises & Precautions
- Total Knee Arthoplasty Exercises
- Using A Cane
- You and Your Hip
- You and Your Knee
- Booking Request
- Consent to Treatment
- Patient Instruction Sheet
- Family Physician Instruction Sheet
- Pre-Admission & Day of Surgery Orders
- Pre-Operative History & Physical Exam
- Pre-Operative Patient Self-Assessment
- Requisition for General Diagnostic Imaging
- Cancellation / Change Sheet for Pre-Admission/ Operating Room
- Advance Request for Pre-Admission Appointment
- Pre-Anaesthesia Screening & Medical Optimization Tool
- Choosing Wisely Pre-Operative Clinic Testing
- Recommendations for Day of Surgery Medications