The PreOp-Guide
A Patient's Guide To Surgery
Chapter 3
Inpatient Surgery
     Inpatient surgery is rapidly becoming a thing of the past in the current medical-economic climate.  Operations that routinely required a 2-day hospitalization only 10 years ago are now being performed on an outpatient basis.  Consequently, people who require admission following their surgery tend to have had major procedures.  Hopefully, by this time your physician has told you whether or not you are going to be admitted to the hospital after your operation.  If this has not been discussed yet, ask the next time you talk to your surgeon or one of his or her staff.  

     In reality, the trend toward outpatient surgery is not all bad.  There are many benefits to recovering at home.  The hospital is basically a building full of sick people, many of whom are carrying dangerous viruses and bacteria.  In this day and age, if you absolutely don’t need to be in a hospital, you shouldn’t be.  On the other hand, there are obviously services provided in a hospital that cannot be provided anywhere else.  Additionally, nearly all hospitals are staffed 24 hours a day, 7 days a week, 52 weeks a year by physicians, nurses, respiratory therapists, radiology technologists, and numerous other allied health professionals.  For surgical patients, the decisions regarding hospital admission are based on the issues of pain control, ambulation (that is, the ability to get around), nutrition, respiratory function, and surgical drain management.  Typically, surgical patients will have issues in one or more of these fields, and once all of the problems have been addressed, it will be time to go home to complete the recovery phase of the operation. 

     When talking with your surgeon about your admission, you should ask how long a typical patient remains hospitalized after operations of the type you are having.  You must take into consideration you personal attributes as well when you consider the answer.  I have known many patients who left the hospital of their own volition when I would have preferred they remain in bed.  I have also known people who virtually had to be chased out of the hospital with a stick despite having recovered quite well.  Your surgeon will be able to assess your condition and give you a fairly accurate picture of your estimated length of stay.  This presupposes that the operation will go technically well and that you will recover without any complications.  Since this is the case in the overwhelming majority of procedures, you can rest assured that almost everyone will be home within a day or two of the doctor’s estimate.  You should also ask you doctor how long it will be until you are well enough to resume work or your favorite leisure activities.  Frequently you will be home days to weeks before you are feeling up to a game of golf or a day at work.

     Once you have an idea how long you are going to be in the hospital, you can begin to plan what you need to bring with you.  The first thing you should remember to pack is your completed PreOp-Worksheet.  Keep it where it is easily accessible; in fact, you may even want to make a few copies of it so that you can give it directly to the numerous nurses, administrators, discharge planners, and physicians who will be attending to you during your stay.  Beyond that, you should bring a few of the most basic necessities of comfort and hygiene.  Remember that even if you show up with nothing but a smile, the hospital will be able to provide everything you need to complete your stay.  I personally prefer my own toothbrush to a disposable brand, so I suggest bringing your own.  If you wear dentures, bring the cleaners and bonding agents you need.  Hearing aids with fresh batteries are important for those who need them, as they will improve communication with the hospital staff.  If you wear glasses, bring the oldest pair you have that still allows for adequate vision.  You will find that small objects such as glasses have a way of losing themselves during your hospital stay.  An inexpensive watch or travel clock is always nice, but unfortunately things of value have a tendency to disappear from hospitals as well.  For traveling around the building, a light robe and a pair of slippers are welcomed additions; the outfits provided for hospital patients tend to be flimsy and leave you somewhat exposed.  A pair of sweat pants and a sweatshirt are reasonable items to bring, particularly in cold weather.  If you have a tendency to feel cold, an extra shawl or blanket may also be useful.  Some people like to bring their own pillows; but beware, they will always leave stained with blood, sweat, and other body fluids.  The recovery period following surgery can be pretty messy.  Underwear is a luxury you may not be allowed to enjoy, depending upon the site of surgery; but bring an extra pair or two and I guarantee you won’t regret it.  Some women also find that a very basic makeup kit allows them to manage their looks at a very stressful time.  A common joke among hospital staff is that once a woman patient feels well enough to apply makeup, it’s time for her to go home.

      If you enjoy reading or playing cards, bring along a book or deck of cards to pass the time.  The small hand-held electronic games seem to be a particular favorite these days, but again remember that you should not bring anything that you do not want to lose.  In terms of money, you will find that having a little pocket cash comes in handy.  Most hospitals will provide you with a personal telephone and television set, but increasingly you will find that there is an up-front daily charge for the use of each.  Additionally, there are newspapers and magazines for sale, as well as snack foods (for those of you who have and appetite or will be allowed to eat).  A fair estimate for daily expenses is dependent upon where in the country you live, but $10-15.00 a day should be adequate for most patients.  I would advise that you have the money brought in to you on a daily or every- other-day basis, as you would not want to keep a large sum of money lying around.  Remember that you will be sleeping for most of the days and nights following surgery, and no fewer than a dozen people will pass by your bedside each and every day.  I am not implying that hospital staff cannot be trusted. Remember there also will be other patients and their visitors wandering the halls.  I can recall more than a few con artists and petty thieves who’ve made their own rounds on the wards, preying on the ill and defenseless.

     Perhaps as important as what to bring to the hospital is a list of the things you should not bring.  As I mentioned above, objects of value tend to disappear in the hospital.  For this reason, there is absolutely no reason to bring jewelry of any kind with you, this includes rings.  In fact, if you develop severe swelling postoperatively, you may find that someone will actually cut the rings off your fingers so you don’t lose circulation (this happens all the time).  In order to avoid the loss or destruction of valued personal items, just leave them at home.  Purses and wallets also have no place at the bedside.  Of course, you will need a form of identification and your insurance and/or Medicare/Medicaid cards, so plan to bring these in an envelope or small change purse.  Finally, you will have little need for street clothes and shoes (except on the day you are discharged).  If you will have friends or family members visiting, have them bring in your clothes the day prior to discharge (or when they come to pick you up for that matter). 
     When planning your arrival to the hospital, you should check with your doctor’s staff to determine what time to arrive.  In a bygone era, patients were admitted a day or two before their operations to complete the preoperative preparations.  Intravenous lines were established, bowel preparations were administered, and laboratory tests were drawn.  Today most of the preparation will be completed before you arrive at the hospital.  Most institutions require you to arrive several hours prior to the procedure so that you may complete the admission paperwork and get changed.  Admitting centers typically have a place for you to store your belongings during surgery and allow you to change.  If possible, it is nice to have someone accompany you to the hospital for this process, as there are always things that need to be returned home, and frequently there is a fair amount of waiting time before going to surgery.

     There are several things you should keep in mind when you get to the hospital.  The first is that the admitting staff does not bear any responsibility for the delays you may possibly face.  Surgeons schedule cases to follow one another, and unless you are the first case of the day, it is highly likely that your operation will not begin precisely at the time scheduled.  When planning operative schedules, operating room personnel allocate a standard amount of time for each type of operation.  The law of averages holds that in half of the cases it will take less than that amount of time to complete the operation, and half of the time it will take longer.  Therefore, be prepared to have you operation occur hours earlier or later than scheduled.  On occasion, operations are also canceled, opening holes in the OR schedule.  In order to make the most efficient use of operating room time, you may be asked to come in early for your surgery as well.  Remember also that in most communities surgeons are a scarce commodity, and unfortunately emergency situations arise every day that require the unique skills of a surgeon.  If you are unlucky enough to have your elective surgery scheduled at the same time that a person develops appendicitis or a major auto accident occurs, you may find that your case is postponed for hours or perhaps canceled outright.  This can be a frustrating experience, but remember that if the emergency were happening to you or one of your family members, you would want immediate life-saving attention from a surgeon.  Second, there is a fair amount of lag time between when you leave for the operating room and when the operation actually begins.  If not already in place, intravenous access will have to be obtained; you will have to be properly positioned on the operating table (a very important step to avoid complications); surgical instruments and monitors need to be applied to your body; anesthesia must be induced; and a sterilizing procedure must occur before the surgeon may begin the operation.  Problems with one or more of these routine events occur daily.  Optimal surgical care requires perfect integration of services provided by ten or more people. A problem in any phase of this care can lead to frustrating delays, but again, perfection is the only option when performing surgery.

     I hope this chapter has provided you with an idea of what to expect when you show up for your inpatient surgery.  The bottom line, I suppose, is that you are embarking upon a journey with many variables.  You will be in a state of heightened anxiety, and small frustrations will undoubtedly cause you major stress.  If you head in to the situation aware of the possible pitfalls and eventualities, you may be able to better manage your worries and concerns, and understand what is happening to you.  If all else fails, bring an enjoyable pastime, and do your best to relax and remember that when you get into the operating room you want everything going your way.

Chapter 2
Chapter 3
Chapter 1
Chapter 4
Chapter 5
Chapter 6
Chapter 8
Chapter 9
Chapter 10
Chapter 11