Day of surgery
Morning of surgery
Take only the medications that the preadmission nurse or preoperative physician has instructed you to take with the smallest sip of water.
Arrival at the hospital
Please arrive on time. Upon arrival, you will meet members of our team, and our staff will ask you to provide the name and cell phone number of your designated contact (likely your “coach”).
All four hospitals are equipped with waiting areas and free Wi-Fi for friends and family.
Lankenau medical Center
100 East Lancaster Avenue, Wynnewood, PA 19096
Come to the main hospital entrance where valet parking is available. The registration desk will guide you to your destination. Family can wait in the Sun Room, located on the 4th floor between the Pew and Rosengarten buildings, next to the elevator lobby.
Bryn Mawr Hospital
130 South Bryn Mawr Avenue, Bryn Mawr, PA 19010
Come to the Warden Lobby entrance (830 Old Lancaster Road). Sign in at the registration desk, where you will be directed to the Green Room, our surgical waiting area on the 3rd floor. Friends and family can also wait comfortably here.
255 West Lancaster Avenue, Paoli, PA 19301
Come to the Department of Surgery desk in the Atrium lobby. The Atrium lobby is where you will check in and it is also the waiting area for your family and friends.
1068 West Baltimore Pike, Media, PA 19063
Come to whichever entrance you were instructed by the person who called you the day before surgery. Family will be directed to one of two waiting rooms: Rothman surgeons prefer the 4th floor waiting room; Premier surgeons prefer the second floor.
Checking into the hospital
At check-in, you’ll be escorted to the holding area, where you’ll be for one to two hours. A nurse and anesthesia team member will:
- Discuss final preparations for surgery
- Measure your vital signs
- Have you change into a gown and remove your undergarments
- Cleanse you with antibacterial wipes and swab your nose to prevent infection
- Place an intravenous line to administer antibiotic and pain medications
For safety, the surgeon will ask you to confirm your type of surgery (for example, lumbar laminectomy) and surgical site (for example, low back), before marking the site and confirming your consent. You will meet with the anesthesiologist regarding your anesthesia options (spinal vs. general).
In the operating room
After surgical prep, you will be transported to the operating room where we will:
- Apply leads for monitoring
- Insert a urinary catheter if needed
- Administer anesthesia (spinal or general)
The surgeon will then perform the procedure. A member of the anesthesia team will monitor and remain with you during the entire procedure. At the completion of your procedure, you will be taken to the Recovery Room/Post Anesthesia Care Unit (PACU).
After surgery you will meet the nurse who will care for you during your stay in the PACU. The nurse will:
- Apply monitors
- Take vital signs every five to 15 minutes
- Make sure you can feel your feet and wiggle your toes
- Monitor your pain level (on a 0–10 scale)
- Medicate you as needed
When you are recovered from anesthesia, you will be taken to your new room. You will be cared for by an entire team of professionals under the direction of your surgeon. After surgery, you may be seen by the surgeon, resident, nurse practitioner and/or physician assistant to monitor and assure the best possible recovery and care from your surgery. The surgeon will update your coach after your surgery while you are in PACU.
In your room
When you arrive in your room you will:
- Receive a nursing assessment
- Have your vital signs taken often for the first 24 hours and less frequently as you become more awake and alert
- Be given clear liquids and advanced to solid food as per your surgeon
- Be asked about pain
Your nurse will partner with you to always control your pain using the pain scale (0–10) as was done in the recovery room. The nurse will also assess your surgical dressing, drains and pumps, and orient you to your room and unit (for example, the nurse call light). Members of the care team will instruct you on how to perform exercises that will speed your recovery.
In your room you will also do exercises, such as:
- Ankle pumps: 10 times each hour while awake
- Cough and take deep breaths: 10 times each hour while awake
- Incentive spirometer exercises: 10 times, every one to two hours while awake
Fluid can collect in the lungs after any surgery. Using the spirometer will help you breathe in and out correctly. The staff will instruct you on how to use this effectively.
Members of the care team will be visiting you frequently throughout your stay to check on your well-being and comfort.
Pain medication and monitors
You’ll be connected to a monitor to ensure you’re breathing fully. In order for you to be comfortable and so you can walk early with assistance, you’ll receive different types of pain medications after surgery. You will receive medication when your pain increases as well as 30 to 45 minutes before walking and working with a physical therapist. Our goal is to minimize your pain so you can focus on healing. Keep in mind that:
- Pain after surgery will be different than the pain you may be feeling now.
- Pain comes from multiple factors, including muscle healing, incision, bone pain and swelling of the joint.
- You will be given different types of pain medication on a schedule. Your nurses will tell you what they are giving you.
- Notify your nurse if you feel that your pain is not well controlled.
For pain, your doctor may prescribe one or both:
- Patient-controlled analgesia (PCA) pump—a pain medication pump that you will use during the first 12 hours or more by pushing a button when you feel pain, in order to receive a small dose of pain medication periodically.
- Multimodal pain medications—a combination of medications that work together on a schedule to reduce your pain after surgery.
Preventing blood clots
Early walking after surgery is key to preventing blood clots. The nurses and physical therapists will assist you with walking after your surgery.
- Your surgeon may or may not recommend medication for prevention of blood clots. Be sure to follow your discharge instructions.
- Your surgeon may or may not order the use of sequential compression devices (SCD) or compression stockings to reduce blood clot formation.
- Your SCDs need to be worn as prescribed by your surgeon.
If your surgeon wants your SCDs on at all times except when you are actively walking, please partner with the nursing staff to alert them when you return from physical therapy, the bathroom or walking so that the SCDs can be reapplied.
What you might need after surgery
Based on your physician’s protocol, you MAY also have any of the following not yet mentioned:
- Oxygen therapy via nasal cannula or mask
- Incision covered with a dressing
- Blood pressure monitor
- Pulse oxygen monitor
- Urinary catheter—to be removed as quickly as possible depending on your surgeon’s orders
- Drain at surgical incision—reduces swelling, drains residual blood and will generally be removed as per your surgeon’s orders prior to discharge
Hand washing and hygiene
Cleanliness is key. Ask for help if needed!
To minimize the risk of infection, we encourage good hand hygiene and other sanitary practices. After your procedure, we encourage you to:
- Remind doctors, nurses and caregivers to wash their hands.
- Wash your hands after going to the bathroom and before and after eating.
- Ask family and visitors to clean their hands when entering and leaving the room.
- Ensure visitors don’t put personal belongings on your bed or in your room.
- Wash your hands before and after physical therapy.
- Remind staff as necessary that during transport, legs should be covered with a clean sheet.
Physical and occupational therapy
Patients who work with a therapist to perform exercises and walk on the day of surgery have been shown to recover and safely go home sooner with greater independence. This helps us keep you safer from the risks of being in a hospital longer than necessary.
Therapy will occur once or twice daily, beginning on the day of surgery to help you recover your mobility, strength, range of motion and independence.
Physical therapy will include:
- Moving in bed
- Standing up from a chair, bed or toilet, and transferring in and out of seats
- Climbing stairs
- Walking 50-200 feet, using walkers and other assistive equipment if needed
Occupational therapy will prepare you to:
- Stand, sit, and use a toilet properly
- Bathe, groom and get dressed
- Get in and out of a car
You may or may not need a brace after surgery. Your surgeon will inform you if a brace is required. If it’s required, the staff will instruct you on the correct application and wearing of the brace.
After surgery, you will be given specific instructions regarding your activity restrictions depending on the type of surgery you had performed.
Therapists will educate you about equipment, if needed, to help you resume normal activities. This may include equipment such as a reacher to pick up things off the floor along with other long-handled devices and a cane or walker to assist with safe walking.
Once you are tolerating walking in the halls with the physical therapist, you will be reintroduced to stairs.
Learning to move more safely
Please be advised that you must avoid all strenuous activity until after your first postoperative visit. Your surgeon will then determine your continued physical therapy and activity progression based on your physical progress and surgical site healing.
You will learn how to move more safely. Learn, practice and follow these directions carefully. This will assure your best recovery and protect your neck and back in the future.
- Tighten the muscles in your stomach to support your spine.
- Keep your ears, shoulders and hips in a line.
- Bend at the hips and knees, not at your waist.
- Move your body as a unit. Do not twist your shoulders or waist.
Getting out of bed
- Tighten your stomach muscles. Roll onto your side. Be sure to move your body as a unit. Don’t twist.
- Scoot to the edge of the bed.
- Press down with your arms to raise your body as you gently swing both legs to the floor.
- Place one foot slightly behind the other. Keep your stomach muscles tight and keep your head up eyes looking forward. Then use your leg muscles to raise your body.
Getting into bed
- Back up until the edge of the bed touches the back of your legs.
- Tighten your stomach muscles. Bend forward slightly from the hips.
- Use your leg muscles to lower your body onto the bed.
- Using your arm for support, lower your body onto its side. Roll onto your side. Be sure to move your body as a unit. (Move your body as a unit allowing your feet to lift onto the bed.)
- Roll onto your back without twisting your waist.
- Back up until the front of the chair touches the back of your legs.
- Tighten your stomach muscles. Bend forward slightly from the hips (not the waist).
- Using your leg muscles, lower your body onto the chair. Then scoot back.
To stand up
- Scoot to the edge of the chair. Place one foot slightly behind the other. Use your leg muscles to raise your body.
- Stand with one foot slightly in front of the other.
- Keep your knees relaxed and your stomach muscles tight.
To turn your body
- Move your feet. Step around. Do not twist.
- You may lie on your back with a pillow under your knees.
- Lie on your side with your knees slightly bent keeping a pillow between your knees.
- Keep your head comfortable supported, no extra elevation is needed beyond what you normally use.
Additional tips for moving
Always try to maintain a neutral spine position both neck and back.
- Bend at the hips, or knees, while keeping your neck and back in neutral position such as when sitting down or picking something up from lower level (use a reacher if needed or have somebody else pick it up).
- Sit in higher chairs (use pillow to raise height if needed) with:
- Good lumbar support and armrests
- Feet flat on the floor, hips and knees at 90 degrees
- Hips all the way back in the chair
- Back slightly reclined for comfort
- Weight through sitting bones
- Add a pillow behind your back or neck for comfort to prevent the incision from hitting the back rest.
- Keep items frequently needed (such as telephone/cell phone) in front of you and within reach.
The responsibility of the care manager is to work with your treatment team to plan for a safe discharge from the hospital to home. The discharge planner works in your best interest with your health insurance company to obtain authorization and arrange services and equipment you may need immediately after discharge upon going home. This person also communicates with your physicians, nurses and therapists about your medical progress.
Many factors determine your individual recovery and equipment needs:
- General medical condition
- Progress in meeting physical therapy goals
- Ability to manage the activities of daily living such as bathing, dressing, steps, and transfers in and out of a car
- Home environment and caregiving
- Insurance guidelines
Timing of discharge varies depending on the type of spine surgery you have had. There are several things that need to happen medically along with physically to make sure you are safe to discharge. Upon discharge, you should expect to go home to continue your recovery.
When you go home
Make a follow-up appointment with your surgeon. Please call to arrange if an appointment is not already listed on your discharge instructions or papers from your surgeon’s office.
Follow discharge instructions for post-op primary care appointments. You’ll receive instruction on activity restrictions, new medications/prescriptions, when to safely restart home medications and over-the-counter medications and information on home visits or outpatient therapy if required by your surgeon.
Have someone pick up any home medications and new prescriptions. Once home you may want to have someone stay with you or be available to check on you for the week following surgery.