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This information serves as a pathway, or guide, which outlines some of the steps your health care professional will follow in assisting you to prepare for your surgery.
There are six major steps on your pathway to surgery
There are six major steps on your pathway to surgery
- Step 1: Spinal Surgeon's office visit
- Step 2: Medical office visit
- Step 3: Pre-surgery/Education visit
- Step 4: Preparation for surgery
- Step 5: Hospital stay
- Step 6: Discharge from hospital
The physician’s office will arrange the date for surgery. Typically they will also arrange all of you pre-surgery appointments to complete the major steps in the pathway.
Optional: If you are interested in donating your own blood before surgery this process is called autologous blood donation. This blood would be saved for you and if you required blood during or after surgery the blood would be transfused back to you.
If you are interested in this program, please discuss it with your Surgeon. It would require two or more appointments before surgery. The physician’s clinic will make these arrangements for you. Your autologous donations would be scheduled at the hospital laboratory facility that the physician uses.
Step Two: Medical Doctor's office: (back to the top)
The Spinal Surgeon is a physician who is highly specialized to treat conditions of bones, joints and muscles. They will concentrate on the surgical procedure and will be concerned with returning pain free function to you.
To assure that best outcome for you during surgery and hospitalization, they often requested a medical physician, who specializes in heart, lungs and other body systems, to consult with him/her in caring for you medically. The medical doctor will concentrate on preparing you medically for the surgery and will be involved in your care throughout hospitalization.
What tests will I need?
The following tests will be scheduled for you if necessary:
Those who qualify for the procedure have:
All hospital facilities strive to provide all patients with quality care. You and your family play on important role in assuring that you receive proper care during and after your hospital stay. Nurses, physicians, therapists and other allied health care providers rely on the information that you give them about your health and your home life. This session is on opportunity for health care professionals to gather the necessary information to provide quality, safe care for you.
Many surgeon practices employ the use of a educational session to better inform patients. If your does, more than likely the educational session will provide an opportunity for you to become familiar with the hospital and how this care is provided. We strongly recommend you have a friend or relative attend this session with you. Please dress comfortably for this day. Ladies may wish to wear slacks.
When making appointment you may also be given a date for the Pre-Surgery/Education Session.
If so you should bring the following with you to this session:
As a patient you can also expect a one-to-one Pre-Surgery/Education Sessions with the following hospital personnel:
Weeks before your surgery:
Your nutritional health is important in preparing for surgery. In the weeks prior to surgery you should eat a healthy, well-balanced diet that includes a variety of foods. This is not a time to attempt weight loss. If you have any concerns about your nutrition, talk to your Doctor and ask for a referral to see a Dietician.
The week before surgery:
The week before surgery it is important that you avoid aspirin or products containing aspirin. This includes non-steroidal anti-inflammatory medications such as Feldene, Naprosyn, Daypro and Relafen. If you have questions about stopping any of your medications, please call your surgeon's office.
If you develop a rash, open cut or sore anywhere on your body, especially on the area that is planned to operated on, call the Surgeon's office right away. It is important that your skin be free of any cuts or sores that may cause an infection.
The day before surgery:
For surgery to be performed safely, it is suggested that you observe the following instructions:
Your hospitalization will be approximately four days. This is dependent on your progress in therapy and if you do not develop any complications.
On the following paragraphs you will find an outline of what you can expect each day you are in the hospital. This is only a guide and may vary from person to person.
Tests:
The nurse will be drawing blood at least once a day while you are in the hospital. This blood test will tell the Surgeon how thin your blood is. Each day he or she may order a different dose of Coumadin, a blood thinner, to help prevent blood clots after surgery. The nurse will also run a test to check the level of hemoglobin in your blood. These tests are routine after surgery.
Treatments:
The night before your surgery you should bathe in your usual manner. In pre-op holding, you will receive IV antibiotics, and then you will be transferred to the surgical suite. When the surgery is completed, you will go to the Post-Anesthesia Care Unit in your bed. You will remain in this area until the Anesthesiologist releases you to return to your room. The nurse will continue to frequently check on you. This is routine and not a cause for concern.
Lines and Tubes:
After surgery, you will have an IV for two or three days after surgery and will receive antibiotics during that time to prevent infection. You may have a drain in your incision. Usually this drain is removed the first day after surgery.
Medications:
You may take your medications as prescribed on the day before surgery. The Anesthesiologist will tell you if you should take your medications the morning of surgery. After surgery the doctors will prescribe the medications you will need. The medications may include pain medication given as a shot in a muscle or in your IV as you need it.
Nutrition:
You may have whatever you like to eat until midnight the night before surgery. After midnight you should not eat or drink anything until after surgery. This includes smoking and chewing gum. After surgery your physician will decide when you can eat and drink. You will start having a clear liquid diet and then may advance to a full liquid diet and finally to your regular diet. This type of surgery usually does not affect the stomach or bowels.
Education and Discharge Planning:
An educational program has been designed to assist you during your hospitalization and when you leave the hospital. A nurse will assist you with your discharge plans.
Step Six: Discharge from the Hospital: (back to the top)
What may I need when I leave the hospital?
Payment for your surgery:
Insurance Coverage:
Most insurance companies require pre-certification or prior authorization for your hospitalization. Some insurance companies require a second surgical opinion regarding certain surgical procedures. You should be familiar with your insurance policy regarding your responsibilities in obtaining pre-certification and second opinion. When pre-certification is not done, your insurance benefits may be significantly reduced. You might be billed for any balance not paid by your insurance company.
Medicare, Medicaid, Champus Coverage:
If you are covered by Medicare, Medicaid or Champus, the federal government has guidelines that they encourage physicians and hospitals to utilize in order to receive payment. Therefore, during your hospitalization the physicians office will periodically review your stay, using those guidelines.
If you have any questions regarding the above information, please call the physician’s business office.
Complications:
Major complications are unusual in a total knee replacement, but things can go wrong despite your surgeon's best efforts to prevent complications. With knee or hip replacement, both short term (in the hospital) and long term complications are possible.
Short term complications include:
Step Two: Medical Doctor's office: (back to the top)
The Spinal Surgeon is a physician who is highly specialized to treat conditions of bones, joints and muscles. They will concentrate on the surgical procedure and will be concerned with returning pain free function to you.
To assure that best outcome for you during surgery and hospitalization, they often requested a medical physician, who specializes in heart, lungs and other body systems, to consult with him/her in caring for you medically. The medical doctor will concentrate on preparing you medically for the surgery and will be involved in your care throughout hospitalization.
What tests will I need?
The following tests will be scheduled for you if necessary:
- Lab work (blood studies, urinalysis)
- Electrocardiogram (EKG)
- X-rays (chest x-ray, and several additional x-rays of your knees, hips, legs and spine) (Please refer to your appointment sheet for dates, times and locations.)
Those who qualify for the procedure have:
- proven severe arthritis
- failure of non-operative treatment
- disabling pain
- health condition that does not otherwise pose an unacceptable surgical risk
- individuals with severe medical problems
- those who have active or chronic infections
- extremely obese and are smokers
All hospital facilities strive to provide all patients with quality care. You and your family play on important role in assuring that you receive proper care during and after your hospital stay. Nurses, physicians, therapists and other allied health care providers rely on the information that you give them about your health and your home life. This session is on opportunity for health care professionals to gather the necessary information to provide quality, safe care for you.
Many surgeon practices employ the use of a educational session to better inform patients. If your does, more than likely the educational session will provide an opportunity for you to become familiar with the hospital and how this care is provided. We strongly recommend you have a friend or relative attend this session with you. Please dress comfortably for this day. Ladies may wish to wear slacks.
When making appointment you may also be given a date for the Pre-Surgery/Education Session.
If so you should bring the following with you to this session:
- Your current medication bottles for health professional review
- A list of allergies, especially for medication
- Insurance, Medicare, Medicaid, social security cards
- Basic anatomy and surgical procedure review
- Review patient surgery pathway
- Question and answer period
As a patient you can also expect a one-to-one Pre-Surgery/Education Sessions with the following hospital personnel:
- Anesthesia - discuss types of anesthesia you will receive.
- Nurse- complete history sheet
- Physical Therapy - instructs in walking and other rehabilitative exercises following your Surgery.
Weeks before your surgery:
Your nutritional health is important in preparing for surgery. In the weeks prior to surgery you should eat a healthy, well-balanced diet that includes a variety of foods. This is not a time to attempt weight loss. If you have any concerns about your nutrition, talk to your Doctor and ask for a referral to see a Dietician.
The week before surgery:
The week before surgery it is important that you avoid aspirin or products containing aspirin. This includes non-steroidal anti-inflammatory medications such as Feldene, Naprosyn, Daypro and Relafen. If you have questions about stopping any of your medications, please call your surgeon's office.
If you develop a rash, open cut or sore anywhere on your body, especially on the area that is planned to operated on, call the Surgeon's office right away. It is important that your skin be free of any cuts or sores that may cause an infection.
The day before surgery:
For surgery to be performed safely, it is suggested that you observe the following instructions:
- You may not eat, drink, smoke or chew gum after midnight the night before surgery.
- In some situations, medications may be allowed the morning of surgery.
- The anesthesiologist will advise you of any medications you may need to continue taking
- Report any changes in your physical condition (cuts, rash, a cold, flu or infection) to your physician
- Do not drink alcoholic beverages for 24 hours before surgery.
- Typically you should report to the main desk at Surgical Center.
- Do not wear cosmetics, nail polish or jewelry.
- You will be asked to remove your eyeglasses or contact lenses prior to surgery. (Bring your eyeglass case or lens case.)
- We suggest you keep no more than $5.00 in your room. If you have valuables, arrange to have them stored in a secure place or send them home with family members.
- Often you can bring personal items from home. Some items that will make your hospital stay more comfortable may include shampoo, shaving aids, slippers, combs, facial tissue, bathrobe, toothbrush and toothpaste.
Your hospitalization will be approximately four days. This is dependent on your progress in therapy and if you do not develop any complications.
On the following paragraphs you will find an outline of what you can expect each day you are in the hospital. This is only a guide and may vary from person to person.
Tests:
The nurse will be drawing blood at least once a day while you are in the hospital. This blood test will tell the Surgeon how thin your blood is. Each day he or she may order a different dose of Coumadin, a blood thinner, to help prevent blood clots after surgery. The nurse will also run a test to check the level of hemoglobin in your blood. These tests are routine after surgery.
Treatments:
The night before your surgery you should bathe in your usual manner. In pre-op holding, you will receive IV antibiotics, and then you will be transferred to the surgical suite. When the surgery is completed, you will go to the Post-Anesthesia Care Unit in your bed. You will remain in this area until the Anesthesiologist releases you to return to your room. The nurse will continue to frequently check on you. This is routine and not a cause for concern.
Lines and Tubes:
After surgery, you will have an IV for two or three days after surgery and will receive antibiotics during that time to prevent infection. You may have a drain in your incision. Usually this drain is removed the first day after surgery.
Medications:
You may take your medications as prescribed on the day before surgery. The Anesthesiologist will tell you if you should take your medications the morning of surgery. After surgery the doctors will prescribe the medications you will need. The medications may include pain medication given as a shot in a muscle or in your IV as you need it.
Nutrition:
You may have whatever you like to eat until midnight the night before surgery. After midnight you should not eat or drink anything until after surgery. This includes smoking and chewing gum. After surgery your physician will decide when you can eat and drink. You will start having a clear liquid diet and then may advance to a full liquid diet and finally to your regular diet. This type of surgery usually does not affect the stomach or bowels.
Education and Discharge Planning:
An educational program has been designed to assist you during your hospitalization and when you leave the hospital. A nurse will assist you with your discharge plans.
Step Six: Discharge from the Hospital: (back to the top)
What may I need when I leave the hospital?
- Home
- Outpatient
- Home Health
- Meals on Wheels
- Social Services or Private Hire Help
- Rehab
- Hospital Swing Bed
- Extended Care Facility (Nursing Home)
Payment for your surgery:
Insurance Coverage:
Most insurance companies require pre-certification or prior authorization for your hospitalization. Some insurance companies require a second surgical opinion regarding certain surgical procedures. You should be familiar with your insurance policy regarding your responsibilities in obtaining pre-certification and second opinion. When pre-certification is not done, your insurance benefits may be significantly reduced. You might be billed for any balance not paid by your insurance company.
Medicare, Medicaid, Champus Coverage:
If you are covered by Medicare, Medicaid or Champus, the federal government has guidelines that they encourage physicians and hospitals to utilize in order to receive payment. Therefore, during your hospitalization the physicians office will periodically review your stay, using those guidelines.
If you have any questions regarding the above information, please call the physician’s business office.
Complications:
Major complications are unusual in a total knee replacement, but things can go wrong despite your surgeon's best efforts to prevent complications. With knee or hip replacement, both short term (in the hospital) and long term complications are possible.
Short term complications include:
- pneumonia - While you are in the hospital you are encouraged to breathe and cough. You may use an incentive spirometer, which is a device that helps you to breathe deeply.
- blood clots in the leg and lung - While in the hospital, patients may be given a blood thinner as well as support stockings and pneumatic compression stockings to help prevent blood clots.
- skin problems - Early activity and frequent repositioning in the bed or chair are important to protect the skin from deterioration that can produce bed sores.
- wound infections - During the hospital stay, antibiotics, cleanliness and diligent wound care help prevent wound infection.
- the level of care you need
- your degree of independence
- available family support
- resources available in your community