Preparing For Surgery - Preparing Your Home
Before coming to the hospital, you can do some things to prepare your home to make your recovery easier, such as:

• Place the telephone in a convenient area, such as near the bed or chair.
• Prepare food or purchase easy-to-prepare foods before you come to the hospital.
• Identify a person who will be able to help you with shopping and other chores.
• Move food, pots, pans and other cooking utensils to high shelves or other counter tops so you can avoid bending.
• Place shoes, clothing and toiletries at a height where you can reach them without bending.
• Remove or secure any throw rugs so you won't trip over them.

Think about what changes you'll make if you need to stay on one floor.

Equipment Needs
You will be fitted for a neck collar/brace or halo brace before surgery. The brace is an important part of your recovery process. Your therapist and doctor may also prescribe several types of medical equipment to help you in your recovery. Insurance coverage for equipment varies from one company to another and may change over time. You should check with your insurance company to find out if you have coverage for durable medical equipment (DME), such as a walker or commode, so you can prepare for any co-pay or equipment that may not be covered.

The physical therapist and home-care coordinator will help order the equipment and verify your insurance coverage. Your medical equipment will be ordered a few days before your discharge and delivered to your home. Please arrange for someone to be home to accept the delivery. Medical equipment may include:

• Walker
• Elevated commode or toilet seat extender
• Tub seat, bench or chair to use in the bathtub or shower
• Long-handled reacher

Hospital beds are necessary only for patients with specific medical needs and must be prescribed by your doctor. Most patients do not require a hospital bed after cervical spine surgery.

Transportation Home
You may travel home from the hospital by car, either reclining in the front passenger seat or lying down in the back seat. You must arrange for your own transportation home. Once you are home you may not drive until told otherwise by your doctor. In fact, it is illegal to drive while wearing a collar or brace. However, you may take short car rides as a passenger. If you have any questions about driving, please talk to your doctor.

Medication
Please stop taking aspirin and nonsteroidal anti-inflammatory medicines (NSAIDs), such as Ibuprofen and Indocin, two weeks before your surgery. If you aren't sure which of your medications are nonsteroidal anti- inflammatory medicines, check with your doctor or pharmacist. Once your NSAIDs are discontinued, you may take extra-strength Tylenol for pain relief. If this does not relieve your pain, call your doctor for other pain-relieving medicine.

If you take aspirin or Coumadin for a heart condition, please contact your doctor for further instructions. On the day of surgery, please bring a list of your routine medications with you to the hospital.

Stop Smoking
If you smoke, it is important that you stop smoking for at least two weeks before your surgery and for six weeks after your surgery. Studies have shown that smoking interferes with healing of your bone graft.

Medical Doctor
Your orthopedic doctor may ask you to visit a medical doctor to be sure you have no health problems that could interfere with your surgery. The medical doctor will confer with your family physician or internist about any specific medical problems you may have. He or she will also follow your medical status during your hospital stay.

Preadmission Testing and Evaluation
Your doctor's office will schedule your appointment to have a preadmission evaluation, which may include some or all of the following:

• Medical history and physical examination by a nurse practitioner
• Anesthesia interview
• Blood and urine tests
• Electrocardiogram
• Spine X-rays, MRI, CT Scan or myelogram as needed
• Patient teaching

Blood Donations
Autologous blood donation is available for patients interested in giving their blood and having it held for their use during and after the operation. About two to four weeks before your surgery you can donate one unit of your blood. You can donate your blood at your local American Red Cross. Your doctor will give you a prescription for this. You may need to take one iron tablet twice daily, starting one week before your first blood donation. Continue taking the iron until you come to the hospital. You can purchase the iron tablets over the counter at your local pharmacy without a prescription. We also recommend that you take one multivitamin daily during the two weeks before surgery.

Evening Before Your Surgery
It is important that you do not eat or drink anything after midnight the night before your surgery. If you are being admitted the morning of your surgery, do not eat any solid foods after 9 p.m., or drink any liquids, even water, after 12 midnight. You should also remove your rings, including wedding bands, the night before surgery, as your fingers may be swollen in the morning.

What to Bring to the Hospital
For your comfort, you will want to bring your own toiletries to the hospital. Also pack underwear and comfortable, loose pajamas or nightgowns. You will also need a robe (not floor length), and slippers or soft, low-heeled shoes with closed backs, such as sneakers, walking shoes or loafers. Please do not bring any valuables to the hospital. If you have equipment such as a walker, commode or long-handled reachers, you may want to have someone bring them in for you after surgery. If you do bring your own equipment to the hospital, please label the items with your name.

What to Expect in the Hospital Morning of Your Surgery
Most patients are admitted on the morning of surgery and should report to the Admission Unit, to be prepared for your surgery. Two visitors may come with you on the morning of your surgery.

To prepare for surgery, the nurse will ask you to remove your clothing (including underwear and socks) and to put on a hospital gown. In addition, you should remove any contact lenses, dentures, wigs, hairpins, jewelry, and artificial limbs. Please give these and other personal belongings to your visitors to hold while you are in surgery and until you are in your assigned room. You will be asked to go to the bathroom to empty your bladder before you leave your room.

An escort will transport you to the Operating Room on a stretcher about an hour before your surgery is scheduled. At that time, the nurse will direct your visitors to the Surgical Family Waiting Area where they can wait during your surgery. When the surgery is over, your doctor will phone your visitors there.

Before entering the Operating Room, an anesthesiologist will ask you a few questions and begin an intravenous line in your arm. Antibiotics will be started intravenously and continued after the operation to help decrease the risk of infection. Once you are in the Operating Room, you will be given the anesthesia that you and the anesthesiologist have discussed. Your surgery will take several hours. This period includes the skin preparation, positioning and anesthesia time. Some patients require spinal monitoring called somatosensory evoked potentials (SSEP) during the procedure to help protect their spinal cord and nerves during the operation. If you are having SSEP, a technician will place adhesive electrodes on your body.

After surgery you will awaken in the Post-Anesthesia Care Unit (PACU) or recovery room to recover from anesthesia. This usually takes an hour and a half to two hours. There, the nurse will frequently monitor your vital signs (heart rate, blood pressure, temperature and respiratory rate). The nurse will also be checking your dressing and the circulation as well as movement in your toes and legs. A surgical team member will tell your family when the surgery is over.

Hospital Care
Although each patient's procedure and recovery is different, the usual hospital stay for cervical spine surgery is one to two days. Most patients will be discharged home but some may go to a rehabilitation facility before returning to their home. Each patient will be evaluated during the hospital stay to determine if he or she needs rehabilitation. If you will be returning home, your doctor may ask the home care coordinator to arrange for a visiting nurse and/or therapist. If you will be going to a rehabilitation center, the social worker will coordinate your transfer.

The goal of your care after surgery is to help you become independent so you can return home. By discharge, you should be able to:

• Get in and out of bed yourself
• Walk in the hallway with or without a cane or walker
• Climb stairs, if needed at home
• Bathe and care for your personal hygiene
• Understand all instructions for your recovery

To help you reach these goals, the staff will help you as needed, but they will also encourage you to actively participate and do as much for yourself. When you wake up after surgery, you will be in bed on your back, wearing a neck collar/brace. You will be helped in getting out of bed and will begin your activity program the evening of your surgery. The activity program includes leg exercises, walking, stair climbing, activities of daily living such as bathing and dressing and home management.

Authors:
Rothman Institute
Department of Home Healthcare
Department of Nursing
Department of Orthopaedic Surgery
Department of Rehabilitation Medicine