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Air travel soon after surgery is a controversial issue, for which you often won't get a clear answer. The main divisive issue is the risk of thromboembolic disease, which is increased by both the upcoming flight and the recent surgery. In this article we will look at what the existing (albeit limited) guidelines are, as well as the potential implications for air travel after surgery.  

Orthopaedic procedures

You can use the list below as a rough guide to the minimum time you need to wait from your surgery in order to fly safely. In any case, however, you should consult your treating surgeon:

• Arthroscopy: 1-2 days after surgery.
• 1-2 days after cast or splint application – check airline guidelines.
• 4-5 days after open, simple surgery (eg wrist or hand surgery).
• 14 days after major surgery (eg, shoulder arthroplasty).
• 14 days after fracture fixation.
• 3 months after knee or hip replacement, since dislocation precautions are not compatible with common airplane seats.

Other procedures

• Abdominal surgery: 5-10 days depending on the complexity of the surgery
• Brain surgery/neurosurgery: 6 weeks
• Thoracic/bypass surgery: 10 days, if there are no complications
• Lung surgery: 3 months
• Cataract surgery/eye surgery: 2-10 days, depending on the complexity of the surgery
• Retinal detachment: 6 weeks
• ENT middle ear surgery: 4-6 weeks
• Colonoscopy: 24 hours, if there are no complications
• Heart attack: 7-10 days, if there are no complications
• Heart failure: No problem flying as long as the condition is under control
• Pacemaker: Patients with a pacemaker or implantable defibrillator can travel freely as long as they are medically stable

Things to check before flying

Airline

Each airline has its own guidelines for flying after surgery, which you should look up before you fly. Some companies may charge you for an extra seat, or charge you for an upgraded seat, if you cannot sit down or do not fit in a single seat. In some cases, a “fit to fly” certificate may be required from your doctor, especially if you need special equipment or oxygen during the flight. 

Below are some related airline links you may be interested in:

• Aegean Airlines
• British Airways
• Lufthansa
• Swiss

Travel insurance

If you have travel insurance, check the terms of your policy carefully as you may need to state that you have recently undergone surgery.

Airport security

If your orthopedic surgery involved implants (screws, plates, wires, etc.), be prepared for additional security measures at airport checkpoints. Depending on the type of prosthesis, metal detectors may be activated and you may be asked to undergo additional scanning tests, or undergo a physical examination. It's a good idea to alert security staff that there may be a problem before going through the scanners.

Medications

If you need to take a flight after surgery, it is good to know the current rules regarding the transport and use of your medicines:

• In flight – some companies may have restrictions on the use and transport of medication during the flight, or have rules about the amount allowed.
• Outside the country of origin, or
• Within the country of destination. 

Please note that some drugs that are freely available in one country may be considered a controlled substance in your destination country. It is good to always have a copy of your prescription from your general practitioner with you, to know the active medicinal substance (not just the commercial one) and to be clear about the indication (exactly for what condition you are taking the medicine in question).

Before departure

• Pack your bags on time.
• Get a good night's sleep the night before your flight.
• Wear loose, comfortable clothes on the plane.
• Check any hand baggage restrictions with your airline.
• Plan your route to the airport. Book train or bus tickets or car parking. Check the travel news before you leave and allow enough time to get to the airport.
• If you are taking medications that can cause side effects, such as nausea or vomiting, it is a good idea to have medications available to treat these side effects as well.
• If you are at increased risk of developing deep vein thrombosis (DVT), see your doctor before you travel.  Your doctor may recommend that you wear elastic stockings or give you aspirin or low molecular weight heparin for prophylaxis.

Traveling with a cast or splint

After a cast is applied, there is a risk of swelling or oedema, which can affect your circulation. Most casts are applied in a way that allows the swelling to fluctuate. If you have a circular cast, this should be split or bivalved before flight.

Most airlines will allow you to fly within 24 hours of having the cast applied, for flights that are less than 2 hours long, or after 48 hours for longer flights.

If you are flying 24-48 hours after having a cast placed, your airline may ask you to split the entire length of the cast to avoid problems with your circulation. To avoid disappointment, ask Dr Panagopoulos to arrange this for you, before your flight. 

Our seat in the aircraft

If you have an upper limb brace or splint, or your leg is in a cast that allows you to bend the knee, you will be able to sit in a normal seat.

If the cast covers your knee and you cannot bend it, you will need to discuss with your airline about the ideal position for you. Some airlines may require you to purchase an additional seat, depending on the situation.

Also, for safety reasons, you will not be able to sit in one of the emergency exits, where the seats have more legroom. In any case, ask about the exact cost associated with your chosen seat preferences.

Wheelchairs

If you have a cast on your leg and need a wheelchair to get around the airport and board the plane, let your airline know as soon as possible so that this can be arranged in time, both on departure and arrival. There is usually no extra charge for this service.

Crutches

If you use crutches to support your weight, you must inform your airline. Most airlines will let you take your crutches on the plane and the cabin crew will make sure they are stored in a safe place during the flight.

During the flight

It is important to stay well hydrated during the flight. Drink plenty of fluids, but avoid alcohol or caffeinated drinks, as they will make you thirstier.

Wear glasses instead of contact lenses because the dry air in the airplane cabin can irritate your eyes if you wear contact lenses.

Move around the cabin. Sitting still can increase your risk of deep vein thrombosis (DVT). It is good to do some simple exercises during the flight. Bend and straighten your legs, and walk around the cabin whenever you can. 

Ear problems

The change in cabin air pressure as the plane takes off and lands can be painful as your ears adjust. Yawning, swallowing, or chewing gum may help. Wake up about an hour before landing so your ears have time to adjust to the descent.

If you are traveling with a baby, don't feed it during take-off and landing. It is not recommended to fly if you have an ear, nose or sinus infection, as the swelling can cause pain, bleeding or eardrum perforation in extreme cases. If you must fly, ask your doctor or pharmacist about decongestants to help reduce swelling in your ears.

If you have recently had any type of ear surgery, consult your doctor or specialist before flying after surgery, as some operations, especially on the middle ear, make flying prohibited for a few weeks.

Cabin air quality

Most airplanes are equipped with air filters that change the cabin air every few minutes. There is no evidence that air conditioning systems on airplanes transmit infectious diseases. You can catch infectious diseases, such as the common cold, simply by sitting near someone who is infected or by touching an object such as a doorknob. 

Traveling abroad with medications

• Carry your medication in your carry-on with a copy of your prescription. 
• Check before travel what airline regulations allow and what not.
• Always transport medicines and medical equipment (needles, syringes, etc.) in their original, properly labeled containers.
• Pack a backup supply of medication & a copy of the prescription in your suitcase in case you lose your carry-on. 
• Make sure that the expiry dates of your medicines will be valid for the duration of your visit abroad.
• If you are taking drugs that are considered controlled, either in the country of destination or in the country of origin, it is a good idea to have a letter from your personal doctor clarifying the diagnosis, dosage, indication and the exact amount you are carrying.  

Flying after surgery & blood clots (DVT)

Immobility during air travel, the pressure exerted by a cramped and uncomfortable seat, dehydration and poorer oxygenation are some of the factors that play a role in the formation of a clot. The exact incidence of thromboembolic disease during air travel is not known. According to recent studies, the risk of venous thrombosis increases significantly if the flight lasts more than 4 hours. An air journey > 4 hours increases the risk 2 – 4 times. A trip > 12 hours increases the risk of thrombosis tenfold. Symptoms of venous thrombosis or pulmonary embolism do not always appear immediately. They can appear up to 8 weeks after travel.

There are certain risk factors that predispose to venous thrombosis during travel:

• Personal or family history of venous thrombosis
• Taking birth control pills – pregnancy
• Recent surgery
• Recent cancer diagnosis (especially the first 3 months)
• Thrombophilia
• Obesity (BMI > 30)

To avoid blood clots during long journeys, the World Health Organization recommends:

• Wear comfortable clothes
• Walk often and drink plenty of fluids 
• Change posture regularly and do leg exercises
• Leave the space under the front seat empty so that there is freedom of movement for the legs

Compression with special elastic stockings and sometimes prophylactic administration of low molecular weight heparin (2-6 hours before travel) or aspirin before flying after surgery are recommended for people at high risk of thrombosis. Evidence regarding thromboprophylaxis is controversial.

Dr Panagopoulos is an Orthopedic Surgeon with many years of experience in orthopaedic trauma. Contact us to resolve any questions before the trip.

FAQs - Frequently Asked Questions