Patients who are scheduled to undergo a surgical procedure often have a number of questions and concerns, as well as some degree of anxiety about this experience and their upcoming hospitalization. At the Hospital for Special Surgery, all patients are supported by an institution-wide commitment to safety and comfort. In addition, every individual scheduled for an inpatient procedure and some select ambulatory surgery patients, meets with and is evaluated by an HSS-affiliated internal medicine physician in collaboration with the Division of Perioperative Medicine. The focus of perioperative medicine is to optimize the health of all HSS patients.
Physicians in the Division of Perioperative Medicine are HSS internists who place special emphasis on evaluating the patient’s health status prior to surgery, developing a “risk assessment” based on his or her medical history, and monitoring the patient’s progress before and after surgery. A comprehensive plan is developed for each patient to ensure that surgery is appropriately timed and that risk is minimized. Practitioners of perioperative medicine are also attuned to individual patient needs before, during, and after surgery. (For more information on how risk is assessed, please refer to Understanding Perioperative Care.)
In addition, the Perioperative Medical team works with colleagues throughout the hospital to ensure that all medical needs are addressed and that discharge from the hospital is safe and smooth. The physicians in the Division of Perioperative Medicine, in addition to some rheumatologists within the Department of Medicine, have a full-time commitment to working within HSS and do not have an independent practice outside of HSS. Essential team members also include nurse practitioners, who have specialized experience in areas such as endocrinology and cardiology, nutritionists, physical therapists, and medical specialists.
When scheduling a procedure with a surgeon, patients are advised to obtain an estimate of how long you will be in the hospital. This will vary depending on the nature of the surgery and anticipated recovery time. Make sure to plan accordingly, considering work schedules, holidays, and upcoming family plans. It’s also helpful to expect that the following issues will be reviewed during the weeks and days leading up to surgery
One or two days 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 morning of surgery, and you will be reminded not to eat anything after midnight and to drink only clear liquids up to 2 hours before surgery. This does not apply to the medications that you have been instructed to take the morning of surgery with a small sip of water.
On the morning of your surgery,
Depending on the nature of the scheduled surgery, most patients at HSS receive either general or regional anesthesia.
In the operating room, the anesthesiologist will attach a blood pressure cuff and EKG leads (to help monitor your heart), and will administer 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.
Patients remain in the recovery room until they are fully awake. 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.
During recovery from surgery, all patients are monitored by their internist and PA. Patients also receive care from nurses, nurse practitioners, physical therapists, social workers, nutritionists, and other medical specialists as needed. Most patients begin working with a physical therapist the day after your surgery. This is an important part of recovery that allows patients to return to normal activities as quickly as possible.
Discharge from the hospital usually occurs after one to four days of recovery. For more information on discharge, see Preparing to Leave the Hospital below.
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 place a small plastic catheter in the lower back. This will allow you to receive a continuous infusion of pain medication after the surgery and will make your recovery much more comfortable. Another option is called intravenous patient-controlled analgesia, or PCA in which a button may be pushed to administer a small dose of intravenous pain medication at specified intervals, on an as-needed basis. At times, patients receive pain medication orally.
At HSS, perioperative services have been enhanced by the introduction of specialty nurse practitioners - registered nurses with advanced clinical training in a specific area of care. These areas include endocrinology, cardiology and geriatric medicine. A perioperative psychologist is also available. Patients with a specific condition such as diabetes or a heart condition can expect to be followed by these professionals throughout their hospital stay; however, these members of the team are available to all patients should the need arise.
Together with the Case Management team, Perioperative services help each patient make the transition from hospital to home. Case management assists patients in determining which services their insurance will cover, how to arrange transportation to another facility if necessary, and help ensure that a family member or other caregiver is available at the time of the patient’s discharge from the hospital. In some cases, Visiting Nurses Services will be consulted in advance of admission to make sure that the patient returns to a safe home or other environment.
Often, patients are discharged while still taking Coumadin, an oral anticoagulant. This drug treats existing blood clots and helps prevent new ones from forming following orthopedic surgery. An HSS staff member meets with each patient prior to discharge to identify the healthcare provider who will be monitoring his or her Coumadin therapy. Regular blood tests are an important part of ongoing post-surgical care. Learn more about continuing Coumadin therapy after hospitalization.
As part of an institution-wide commitment to ensuring the best possible outcomes for surgical patients, the Division of Perioperative Medicine was created within the Department of Medicine of Hospital for Special Surgery. The goals of the Division are to focus on patient care, education, and research.
Written by Nancy Novick