After having my collarbone break for what seemed like the billionth time, I had it totally removed in January. Turns out they are over-rated as my posture is better now and no more pain from a bone that kept moving around when I moved. But that is besides the point.
My endo sent a letter clearing me for surgery after doing a full run of blood tests and levels with the recommendations on how to accomodate my CAH. It's important it is put into writing because there is also an anethesiologist involved and you don't want him or her getting the information second-hand. In fact, my ortho wouldn't do the surgery until the information was in hand in writing.
The surgery would normally have been done in an outpatient center but the ortho wanted me admitted due to the chance of crashing during or afterwards which was probably a good move on his part. There was also the risk of vascular damage due to the artery and nerve bundles up there. I would recommend you have your endo request that it be done in the hospital vs. an outpatient surgery center as well. You'll get a chance the meet the anethesiologist ahead of time and make a point of making sure he or she knows about the CAH. That is the person giving the drugs so it's really the one doctor that needs to know about it. The ortho will be too busy working on the knee to deal with the extra attention the CAH requires. For my surgery, it was about 3 hours long as they needed to pick out all the little pieces of bone and broken hardware previously put into place.
The endo recommended that I take my regular dose of florinef and doubling my prednisone the morning of the surgery with a small sip of water. During surgery they had me on a drip of hydrocortisone and for the two days I was in the hospital afterwards gave me extra via the IV. They began to wean it down after about 24 hours. I felt fine once I woke up from the surgery (actually I woke up while I was still in the OR due to some type of bile which came flying out when they pulled the breathing tube out of me which kind of freaked me out for a moment because the surgeon was still putting the final stitches in me at the time). Once I was home, I continued to double up for about a week which the endo felt was overkill but it made me feel more secure to do so.
Good luck.
