Years ago, when I worked as a surgical nurse, things were different. Patients came into the hospital the night before surgery and a major component of their pre-operative care was the education we provided to both the patient and their family (Care Partner).
The content included what to expect and, more importantly, what they would be asked to do to prevent complications and enhance recovery. Although they were often anxious, having a discussion before an individual experienced physical pain made it more likely they would remember our recommendations and do what was required to help themselves afterward.
Post-op was different as well. Patients stayed in the hospital much longer. For example, a gallbladder removal, an outpatient procedure today, involved a five-day stay. This additional time allowed us to provide physical care, adjusting our interventions as necessary, based on progress or complications.
As you can see, there have been a lot of changes over the past few decades! And yet, a trusting relationship with your surgeon and their associates, together with patient education before and after surgery, remains a key component of successful treatment. That’s why I am always looking to engage with surgeons that work with a team to provide a comprehensive approach. Today’s newsletter takes a closer look at what matters.
What You Should Know
Our healthcare system includes very high expectations of what consumers and their care partners can handle at home, without the privilege of onsite clinical guidance.
We expect individuals to follow detailed instructions about what to do the night before and on the morning of surgery. Those instructions might include the following:
- How to prepare your skin
- What medication regimen to follow, possibly including medications to prevent infection, to manage pain, and to prevent constipation
- What to eat and drink and when
- When to arrive at the facility and what to bring or not bring with you
Then, when the surgery is over and the person has recovered enough to be placed in a car for the ride home, the care partner is expected to take over and assimilate all the post-operative instructions. Often, these include:
- How to care for the operative site, including observing for any signs of bleeding or infection
- How to manage swelling with the use of ice and careful positioning
- How to manage pain with a combination of medications, including making judgements as to the need and the effectiveness
- How to manage the risk of infection with the use of antibiotics and/or wound care
- How to accomplish personal care in the face of severe limitations in mobility
- When and how to implement recommended exercise
- How to prevent constipation
- How to recognize if things are not going as expected and when to reach out for assistance
In my experience, when the post-operative care is performed well, individuals experience minimal suffering and recover expeditiously. When that does not occur, it is often the result of:
- Not keeping limbs elevated and icing areas effectively enough to prevent swelling and pain
- Not drinking enough fluids to stay hydrated
- Not preventing the constipation that can result from a combination of anesthesia, insufficient fluid intake, minimized mobility, and pain medications. (For some, this issue can be more problematic than the pain from surgery.)
- Decision making regarding the appropriate use of pain medications
Overall, although post-operative instructions may appear to be simple and easily achievable by an individual and a care-partner, what is missing is clinical judgement and effective problem-solving.
What to Look for From Your Surgeon and Team
When attending physician visits with clients, here is what I look for in a surgeon’s practice:
- A comprehensive explanation of the surgical procedure and what the expected outcome should be on the day of surgery, the first week after, in 6 weeks, in 6 months
- How they provide the education that includes a discussion of the following:
- How to prepare for the event in the days preceding it and what to expect afterward
- A description of anesthesia options, what to expect from the experience of having anesthesia, and how to prevent complications while recovering
- Instructions about post-operative equipment that may be used, including ice packs/machines, splints, slings, etc.
- Creative ways to achieve good positioning to achieve elevation of limbs
- A discussion about pain and effective techniques to manage it, including options in addition to, or in replacement of, prescribed pain medication
- A robust discussion about the appropriate and creative use of prescribed pain medications in combination with over-the-counter options such as Tylenol and anti-inflammatory medications
- An outline of how to resume physical activity, what exercises should be implemented independently, and when to start formal physical therapy
- Established written protocols with clear parameters that take the guesswork out of decision making
- A clear way to be in quick touch with a member of the team if questions or concerns arise
There’s a Lot to Keep Track Of
A client of mine, Julie, recently had rotator cuff surgery and recovered beautifully. I was so impressed as I accompanied her and her husband/care partner, Jim, through it all. But even with all the preparation, and Jim’s obvious motivation to assist, he still required frequent advice. So we communicated regularly through the first post-op week.
When I read the post-op instructions and saw that the protocols outlined to manage swelling, pain, and bowel function required interventions every two hours, I developed a spreadsheet to help Jim track what he was doing and included a space to make notes as to how the interventions were helping or not.
After a few days, as he and Julie were making more mutual decisions, they were able to use the data and discuss what they felt was most helpful at achieving improvement. When Julie returned to see her surgeon, she and Jim brought the spreadsheet to refer to as they shared their experience and articulated their questions. The Physician’s Assistant (PA)was so impressed with their awareness and knowledge, that she asked for an electronic copy of the spreadsheet so that she could offer it to other patients. We were happy to share!
I have spent many years assisting both family and clients with the management of outpatient surgery (the principles are the same for non-orthopedic procedures). Preparation and education are key.
Our system has high expectations of what you and your care partner can manage. It is all achievable. However, having a surgical team that provides comprehensive education and easily accessible support is needed, along with your motivation to strictly follow protocols, document outcomes, relay information, and do what it takes to help yourself.
If surgery is on the horizon for you, I wish you all the best.