What Can I Expect While in the Hospital?
The type of spine surgery you have will determine how long you will need to stay in the hospital and how much help you will need in and out of the hospital after surgery. Many procedures for the spine only require one to three nights stay in the hospital. There are also a number of minimally invasive spine surgeries that do not require hospital stay; rather you will go home on the same day of the surgery. From the moment your spine surgery is completed, the nursing staff will begin monitoring your condition. When the anesthesia begins to wear off, you will be taken to a hospital room until you are ready to go home. When you wake up from surgery, you may feel groggy, thirsty, or cold. Your throat may be sore.
For a few days, you may also have:
- Tubes to drain the incision
- An IV to give you fluids and medication
- A catheter (tube) to drain your bladder
- Boots or special stockings on your legs to help prevent blood clots
Day 0 and Day 1
The day of surgery is called “Day 0,” and the day after surgery is considered “Day 1.” Some spine surgeries require that you wear a brace for a period of time afterward. If so, keep your brace on until your surgeon specifically instructs you to remove it. You will be encouraged to stand, sit and walk (with assistance if needed) within the first 24 hours after surgery. With the supervision of a physical therapist (PT), you will sit on the edge of the bed, stand with support and walk. You may initially need to use a walker to ambulate in the first few days following your surgery. Try not to over do it the first few times you get up and walk. With a number of minimally invasive spine surgeries, you will be ready to go home on the day of surgery. For most others, your pain and discomfort would have improved enough for you to be ready to go home on either Day 1 or Day 2.
Treatments: A nurse will check the circulation and motion of your legs and feet. You will be given an incentive spirometer (sper-ah-ma-ter) (a blue tube you breathe into) to help expand your lungs and prevent pneumonia. Surgical glue, sutures, staples or adhesive tape will have been used to close your incision. The dressing covering your incision may be removed and changed. An ice pack or cooling pad may be used to help decrease swelling and increase your comfort. Your intravenous (IV) fluids will likely be discontinued on Day 1 or Day 2. Your urinary catheter will likely be removed on Day 1.
Medications: You may be given antibiotics through your IV for the first 24 hours to help prevent infection. Pain medication will be made available to help relieve any pain or discomfort you may be having. During the first 24 hours after surgery, you will probably be given pain medications that are injected into your IV line or directly into your arm or buttock. You may instead, have a PCA (patient controlled analgesia) pump. This pump allows you give yourself small amounts of pain medication. These medications are usually much stronger and faster acting than pills taken by mouth. Some pain is normal, even with medication. But if you feel very uncomfortable, tell your nurse. Treating pain before it becomes severe often means that you use less pain medication overall. It is important to keep your pain in check so you can participate in your rehabilitation program. On Day 1, your pain medication may be transitioned from being injected into your IV line to pills that you would take by mouth. This route allows for the medication to last longer in your system than medication given through your IV line.
Diet: How quickly you recover from anesthesia varies from person to person. Your diet will be ordered by your doctor at first, and it will be adjusted as your intestinal function gets back to normal. Usually you will be allowed to have clear liquids as soon as you are able to eat. If you feel okay after drinking clear liquids, you will be given food that is more solid. Special precautions will be taken if you had surgery from the front of your neck.
Activities: Your PT will work with you to begin moving safely in bed and up to a sitting position, and out of bed ambulating about the hallway. Soon after surgery, you will be encouraged to get up and walk. This helps to keep your blood and bowels moving. It also keeps fluid from building up in your lungs. You may require the use of a walking aid (cane or walker) for a short time, and a brace to support your spine. Your physical therapist may suggest exercises to relieve soreness in your legs, such as tightening and releasing your thigh and buttock muscles and pumping your ankles back and forth to keep fluid from pooling in the lower limbs and to help prevent blood clots. Your PT may also teach you how to protect your spine while moving, including tightening your abdominal muscles to “brace” yourself and prevent pain and re-injury.
To strengthen your abdominal muscles, practice this simple exercise:
- Put your hands on the lower part of your stomach
- Gently tighten your abdominal muscles by pulling in your stomach
- Breathe normally without relaxing your abdomen
Tests: You may need to have blood checked for the first day or two after surgery. One of the labs being monitored is your Hemoglobin level. At times after undergoing bigger surgeries, the surgery itself as well as the IV fluids you received may cause your Hemoglobin level to decrease. Given the important role of the Hemoglobin in carrying Oxygen to organs in our body, if your Hemoglobin level drops below certain levels, it is typical for your doctor to order a blood transfusion for you. This is more common after bigger surgeries and as we age.
By your second day in the hospital after spine surgery, you may expect the following:
Treatments: Your IV line and urinary catheter will most likely have been removed. You will probably continue to use the incentive spirometer to help prevent pneumonia. Your wound dressing may be changed or removed. Your surgical drain(s) may have been removed.
Medications: It is natural to feel some pain during the first few days after spine surgery. The pain you may have can usually be controlled with medication, so let your nurse know if you are in pain. By Day 2, you should have likely switched from medications given through injection, or your IV, or PCA to pills that can be taken by mouth. Taking medications by mouth will make things easier when you are ready to go home.
Activities: It is important to continue doing the exercises that have been prescribed by your doctor or PT to help improve motion and keep your muscles from getting sore and tight. Ice packs may be applied before and after therapy treatments to reduce swelling and relieve pain. With assistance from your PT, you will gradually increase the distance you are walking in preparation for going home.
Day 3 and Beyond
Treatments: Your wound dressing will be changed if needed or removed.
Activities: Your physical therapy sessions will continue to focus on safety with mobility, with the goal of enabling you to be independent. In spite of any mild discomfort, it is important that you do your deep breathing and exercises as instructed. Breathing and moving well will help improve your lung capacity and circulation, and may help you heal faster.
You will be able to return home when your doctor feels that your medical condition is stable. You may be instructed to limit your activities for a period of time to give your body a chance to heal. As you prepare to leave the hospital, be sure to follow the instructions provided by your health care team.