After Your Operation
Inpatient Surgery
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 reason. 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.
Outpatient Surgery
The two categories of surgery are inpatient and outpatient surgery. Inpatient surgery simply means that the patient is admitted to the hospital after the procedure. Nursing care, pain medications, and support is provided while the patient remains in hospital and is discharged home when stabilized. In contrast, outpatient surgery refers to procedures after which the patient is discharged home on the same day without a hospital stay. Many patients prefer outpatient surgery since they return home on the same day and can recover in the comfort of their own home. Usually, simpler, less pain generating procedures are performed on an outpatient basis. After the procedure, patients are cared for in the recovery room. Patients are kept there for one or two hours to stabilize and recover from the medications used during the procedure. Patients are then discharged home with instructions specific for their diagnosis. Narcotic pain medications may be prescribed and its important to avoid driving while on these medications. Transportation arrangement should be made prior to the procedure since driving is prohibited after these procedures. Call and make an appointment for one or two weeks after the procedure so that your physician can evaluate healing progress. Common to all procedures is the risk of infections. Common signs of infection include redness to the wound, increased warmth, increased pain, or fluid discharge from the wound. Inform you physician as soon as any of these signs are present. Your physician can evaluate these wounds and initiate appropriate treatment if necessary.
Blood Transfusions
Most surgeries don't require blood transfusions and most surgeons will try to avoid these transfusions if possible. However, if you absolutely need a transfusion several options exist that you should be aware of. The patient always has a right to refuse a blood transfusion, but this decision may have life threatening consequences. The information below will help and inform the patient in this decision making process. This information is only a guide, but your physician can provide you more information regarding timelines and procedures.
Before beginning this page some terms need to be clarified. Autologus blood means using your own blood. In cases that blood loss is anticipated, the patient may choose to donate their own blood prior to surgery so that in case a blood transfusion is needed the patients own blood can be used.
Option |
Explanation |
Advantages |
Disadvantages |
|
Pre-operative Donation. Donating your own blood before surgery |
Your own blood is drawn 2-4 weeks before surgery, is tested, and stored in blood bank until or if needed. |
Avoids the need to transfuse blood from someone else. |
Must be done in advance (2-4 weeks) & may delay surgery. Not all patients are candidates. |
|
Intra Operative (in the operation) transfusion recycling. Also called "Cell Saver" machine. |
Blood lost in the wound is collected by a machine called Cell Saver. The blood is recycled and given back to the patient as needed later.. |
Avoids the need to transfuse blood from someone else. Large amount of blood can be given back during or after the operation. |
Can not use in cancer or infection. Not available everywhere. Rarely can cause allergic reactions or kidney failures. |
|
Hemodilution. Drawing some of patients blood right before surgery and replaced with fluids. |
The drawn blood is replaced by fluids making the total body blood less concentrated. The drawn blood is processed and kept aside. |
Lowers chances for need of donated transfusions. Dilutes the blood and so the blood lost during surgery is relatively decreased. If needed the blood donated previously can be returned. |
Limited number of units can be donated. Not all patients are candidates due to previous medical conditions. Decreases Oxygen carrying capacity of blood. |
|
Volunteer donated blood. From blood banks (supplied by American Red Cross or Hospitals) |
Blood collected in the community from volunteer donors. |
Almost always available in emergency cases or elective procedures. |
Has risk for disease transmission. AIDS 1 in 700,000, and Hepatitis 1 in 3000. Continuously improved numbers with better testing. Compare with risk of driving or walking across the street!!! |
|
Designated Donor blood Transfusion. |
Patient selects a donor (a relative or friend) Must meet the same rigorous requirements of a volunteer donor. |
Can select wife or husband or any other relative. |
Requires advance preparation 1-2 weeks. Risk of disease similar to Volunteer donated blood. Not necessarily as safe, nor safer, than volunteer donated blood |
Some points are important to remember. If blood is donated before the operation, the patients blood will be used first. However, if more blood transfusions are needed Volunteer donated blood must be used. When requesting a family member to donate blood, one should never pressure them to donate blood. They may have a disease not known to other family members and pressuring them to donate may create an unfavorable situation. If blood is donated by a family member, it may have to be irradiated to prevent certain biologic reactions. Always remember, the safest blood is your own, use it when possible. Other general consideration include medical conditions such as lung and heart disorders. Elderly patients can not tolerate low blood volumes compared with young healthy individuals with good heart function. So the threshold of transfusion is lower with elderly patients compared with young individuals.