Inpatient surgery refers to surgery that requires a hospital stay after completion of the procedure. After the procedure the patient is admitted to the hospital for several reasons. The intensity of pain following most procedures is known to the surgeon based on past experience. If the anticipated pain can not be controlled by oral pain medication and requires injectable medications, then the patient will benefit for the stay for pain control alone. Secondly, activities of daily living may be difficult to perform following the operation and a professional staff of nurses and aids can help in these activities until the patient is self sufficient. The patient will stay under the care of a network of staff members. These will include your surgeon, internist, nurses, physical therapist, case managers, social workers, nurses aids, and more. As needed other departments such as radiology, nuclear medicine, or anesthesiology may be utilized.
Pain control is of outmost importance. As the advancement of medical technology continues, so does our ability to control pain. The department of anesthesiology and pain management may provide a Patient Control Anesthesia (PCA) pump. This is a device that can release a continuous flow of medications through an IV and then release an extra dose of medication when the patient pushes a button. The pump can be programmed to release only a set amount of medication to avoid excessive release of medication and can record the amount of medication used by the patient. This record can be examined by the physician which will direct him to adjust the doses according to the patients needs. Patients are kept comfortable allowing them to rest. While resting comfortably, patients usually do not push the provided button and ultimately only use the lowest amount of medication needed to keep comfortable. This is the most efficient method of pain control while using the lowest amount of pain medication.
If blood loss is anticipated, healthy patients may choose to donate their own blood preoperatively. This blood will be checked and held in case a blood transfusion is needed after the operation. Patient undergoing low back fusion procedures have a higher likelihood to need a transfusion. The longer the surgery, the higher the chance for a need of a blood transfusion. This occurs, since there is more muscular dissection, which leads to higher blood loss. Posterior spinal fusions (the approach is made from the back) over several segments have a higher chance to need a transfusion. Periodic blood draws will be made to ensure adequate blood counts, detect possible infection, and avoid drug toxicity. This will be reviewed by your surgeon or internist. In order to qualify to autologus (self transfusion) arrangements must be made several weeks in advance to allow time for testing and preparation of the blood. Directed blood is also allowed which consists of blood donations from close relatives. Even though this idea seems attractive to some patients, research studies have pointed that this method may have higher risks for disease transmission than blood from unknown donors. This may be due to the strict criteria which are usually used for regular blood donations by the American Red Cross. This strict selection process is avoided when blood donation is obtained from a directed relative or family member. In the cases of directed blood donation, three weeks are required for preparation and testing.
Depending on the specific type of surgery, the patient will be discharged when stabilized and pain control is adequate using oral medications. Narcotic medication will usually be prescribed upon discharge. It is important to avoid driving while on these medications. If a fusion is performed on the spine Anti-inflammatory medications are usually avoided since most of these drugs will slow down the rate of new bone formation. The newer class of drugs like Celebrex, Vioxx, and Mobic claim to avoid such properties. However, these claims have not yet been substantiated. For this reason all Anti-inflammatory medications are avoided during the first three months after any fusion procedures to expedite bony healing and return to a functional life style. It should be remembered that the use of medications are best evaluated by your surgeon or physician and appropriate guidance will be provided.
In most cases patients will be instructed to call and make an appointment to see their physician within 2 weeks after the operation. At that time sutures or staples will be removed and the wound will be examined for proper healing. Physical therapy will be provided based on the needs of the patient and the specific operation performed. Generally, we initiate physical therapy once the wound has healed and the scar has matured. In cases of spinal fusion, we routinely elect to avoid physical therapy until bony healing has taken place. The usual time line for a fusion to occur is about 3 months, at which time we initiate physical therapy.
