Undergoing a surgical procedure can be a stressful experience for many patients, but the professional staff at Hospital for Special Surgery is focused on providing you with every tool you’ll need to feel at ease with your upcoming procedure. The following is a helpful timeline to help you understand - and prepare for - each part of your experience at HSS.
The Weeks and Days Before Your Surgery
When scheduling your procedure with your surgeon, make sure you obtain an estimate of how long you will be in the hospital. Depending on the type of surgery, you may go home the same day, or you might be admitted for longer. Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans.
- Clearance: If your surgery requires you to stay overnight in the hospital, you will be referred by your surgeon to an internist for clearance for surgery. If you have a history of medical problems – even if you are scheduled to go home the same day as the surgery - your surgeon will often advise you to obtain pre-operative medical clearance. If you will be staying overnight at HSS and your own internist is on the staff at Hospital for Special Surgery and is available to see you after surgery, then your internist can provide this clearance, which includes a history and physical exam as well as laboratory tests. The clearance includes a history and physical examination as well as laboratory tests. If your particular medical condition requires it, other tests might be needed before surgery, such as an EKG or a chest x-ray; some patients need additional testing such as a cardiac stress test.
- Autologous Blood Donation: Your surgeon will tell you if it is likely that you will need a blood transfusion during your hospital stay. If you need blood during or after surgery, you can donate your own blood for this purpose.
- Medications: You may be instructed by your surgeon and/or primary doctor to stop certain medications (such as strong blood thinners like Plavix or Coumadin) several days to a week before your surgery, depending on the medication. In addition, you may be instructed to take some of your medications the morning of surgery even though you won't be able to eat that morning. It is important for you to bring a list (or a bag of pill bottles) including all your medications to your medical clearance, including vitamins, over-the-counter medications, and supplements (a number of medications and supplements may interact with medications you might receive after surgery).
The day before your scheduled procedure, a nurse from HSS will call you with additional instructions and reminders. You will be told when and where to come the next morning, and you will be reminded not to eat or drink anything after midnight. This does not apply to the medications that you have been instructed to take the morning of surgery with a small sip of water.
The Morning of Surgery
On the morning of your surgery, you will arrive several hours before your procedure is scheduled to begin.
- The “Holding Area”: You will come to the preoperative “Holding Area”, where you will be prepared for surgery. A locker will be provided for your belongings, but please leave any valuables at home. This includes all jewelry, as you will be asked to remove everything before entering the operating room. You will be asked to change into a hospital gown and assigned a bed in the Holding Area. Your family can be with you during this time. A nurse will start an intravenous line (commonly referred to as an ‘IV’) to give you fluids, and if you are a woman of child-bearing age, you will be asked to provide a urine specimen for a pregnancy test.
- The Pre-operative Exam: A physician’s assistant will take your history and perform a physical exam. The main purpose of this examination is to see if anything has changed since you last saw your medical or surgical physicians. You will be asked to confirm what type of surgery you are having and will be asked to sign consent for that surgery if you have not already done so. Your surgeon or one of his or her assisting physicians will come to speak to you and to sign your surgical site. This is simply a safeguard to confirm where on your body the surgery will be performed. At this time, you will also meet your anesthesiologist who will discuss what type of anesthesia you will receive.
Your surgery can be performed under two major types of anesthesia: general or regional anesthesia.
- General anesthesia involves being put to sleep with medications that are given to you through your intravenous line. Once you are completely asleep, a breathing tube is placed in your windpipe and your breathing will be assisted with a ventilator. You will remain asleep and comfortable until the surgery is complete, at which time you will start breathing on your own, the tube in your windpipe will be removed, and you will awaken comfortably in the operating room.
- Regional anesthesia for surgery involves an injection that will numb the nerves going to the area involved in your procedure. You will be comfortably sedated before the injection, and depending on your preference, can be either lightly or heavily sedated for the surgery. More than 90% of the surgeries at HSS are performed under regional anesthesia. When you receive this type of anesthesia, you will feel no pain during the surgery. As a result, you will need to receive less sedative and pain medication, which will make your recovery faster and you will feel more comfortable and have less side effects such as sleepiness and nausea. In addition, the anesthesia will last for several hours after the procedure, significantly reducing your pain and smoothing the transition to oral pain medications.
If your recovery is expected to require several days in the hospital, your anesthesiologist will choose one of two options to control your pain after surgery. He or she may elect to place a tiny plastic catheter at the site of the injection. This will allow you to receive a continuous infusion of pain medication after the surgery and will make your recovery much more comfortable. The other option is called intravenous patient-controlled analgesia, or PCA. This is a button that you can push to administer a small dose of intravenous pain medication every ten minutes as needed.
The Operating and Recovery Rooms
- Anesthesia/Surgery: After your consultation with the anesthesiologist, you will be taken to the operating room by a nurse. Once there, your anesthesiologist will put on standard monitors, such as a blood pressure cuff and EKG leads, and will begin giving you sedative medication. One of the forms of anesthesia discussed above will be administered, and the surgery will begin. An anesthesiologist will be with you the entire time. When the surgery is complete, your surgeon will speak with your family and you will be taken to the recovery room.
- Recovery: In the recovery room, you will fully awaken from the sedation and will eventually be given ice chips followed by small sips of water. Your doctor or someone from his /her team will come by and speak with you about the surgery and follow-up plan. If you will be going home that same day, you will receive detailed instructions for taking care of yourself at home and a prescription for pain medication. If you will be staying in the hospital for a few days, you will be assigned a room and will go there later that day or early the next morning. While still in the recovery room, your pain will be controlled with the infusion catheter, the PCA, or oral pain medications.
Recovering in the Hospital
- Physical Therapy: The recovery process will be an active one. You will likely begin working with a physical therapist the day after your surgery. This is an important part of your recovery that will allow you to get back to your normal activities as soon as possible.
- Pain Management: An anesthesiologist and nurse from the Acute Pain Service will visit you each day to evaluate your pain, optimize your pain medicine, and treat any side effects. On the first day or two after the surgery, you will be transitioned from the PCA to oral pain medications in preparation for discharge. The Recuperative Pain Medicine Service (RPM) will assist you in this transition and will ensure that a comprehensive and patient-specific discharge plan (including pain management) is in place for each patient, both during their stay at HSS and when they leave the hospital.
- Medical consultant: The internist who saw you before your surgery will see you while you are in the hospital and will be available to address medical issues when needed. The internist will use his/her judgment as to how often to visit you based on the nature of your surgery as well as your medical history. If you have a question appropriate for the medical consultant, you can either call him/her directly, or you can ask your nurse to contact the consultant for you.
After one to four days of recovery, you will be discharged home, likely with a prescription for pain medication, a prescription for physical therapy, and a follow-up appointment with your surgeon.
Based on articles by Dominique K. Kelly, MD, and Tiffany Tedore, MD, Regional Anesthesia Fellows, Hospital for Special Surgery
12/5/2011 Reviewed and edited by Shawna Dorman, MD, 2011-2012 Fellow in Regional Anesthesiology and Acute Pain Medicine