Discharge Instructions
If you had a fusion surgery:
- DO NOT smoke, use chewing tobacco or nicotine gum or wear a nicotine patch. Nicotine has proven to significantly slow bone healing. You are also at risk for infection and poor wound/incision healing which can lead to returning to surgery.
- DO NOT take an anti-inflammatory (ibuprofen, Motrin, Advil) for a minimum of 12 weeks postoperatively unless otherwise told by your orthopaedic doctor.
Your postoperative restrictions
- No lifting greater than 10-15 lbs in the first month and then no lifting greater than 30lbs until 3 months after surgery.
- No repetitive bending, lifting, or twisting activities.
- Aim to walk and work on your exercises discussed and practiced in the hospital with physical and occupational therapy.
- If you have an Aspen collar for your neck, it is typically used for 6 weeks after surgery. You can exchange it for your soft Philadelphia style collar for showering as this one can get wet. Keep your Aspen collar dry.
Pain Control
Take your pain medicines as described. Different medications generally work to decrease pain in different ways and work together to do so.
Wound Care
- Please keep your incision clean and dry.
- Once your incision is dry for 48 hours it is okay to leave it open to air (no dressing) and shower.
- Please DO NOT take a bath, swim or submerge in water.
- DO NOT use Hydrogen Peroxide or Rubbing Alcohol on your incision.
- Wash with anti-bacterial soap/water 48 hours after sutures/staples have been removed.
Things to Consider when Planning for Recovery at Home
- In order to minimize delays, please identify who will help you to get home from the hospital after surgery. Recovery usually takes anywhere from 2 weeks up to a few months depending on the person.
- Most patients are able to be discharged directly home. If so, you should not plan to be alone more than 2 to 3 hours at a time for one week after your surgery, and for at least two weeks after complex spine surgery.
- It will be determined during your in-patient stay, whether you will need to be transferred from the hospital to a Continuing Care Facility (such as a Nursing Home, Skilled Nursing Facility, etc). Many factors will determine if this is necessary, including your rate of recovery, mobility, pain control after surgery, etc. A Case Manager will follow you while you are in the hospital and will work closely with you to ensure your transition from the hospital to your home is as smooth as possible.
- Any home equipment needed will be recommended by Physical Therapy and Occupational Therapy during your hospital stay and will be ordered by our discharge coordinator before you leave.
- Please be advised that insurances do not cover all equipment and some may need to be purchased. Please contact your insurance company if you have specific questions or concerns about coverage. Examples of home equipment typically not covered by insurance: shower chairs, raised/elevated toilet seats, shower grab bars, sock-aids, etc.
- Typically if you are not discharged to a rehab facility; home care is recommended by the health care team, this will be arranged before discharge by our Discharge Coordinator or Case Manager.
- Almost all of our patients are walking at least 50 feet, transferring in and out of bed independently, and are cleared to walk up and down stairs that they need to use at home before discharge.
- If your surgeon determines that you need Out-Patient Physical Therapy, you will most likely be cleared to start after your 4 week follow-up visit. Patients who have undergone spinal fusion will be asked to refrain from Out-Patient Physical Therapy or independent exercises (other than walking) until cleared by their surgeon (typically at 4 weeks post-operative appointment).
- If you should want a personal attendant to assist you at home for bathing, laundry, cleaning, etc. you will likely need to arrange this yourself (it is very unlikely that medical insurance will pay for this).
- Driving: You will be able to drive once you are no longer taking any pain medication, hard collar (if used) has been removed, AND/OR able to maneuver in a vehicle safely.
What to Expect After Surgery
Restrictions
- Depending on the type of surgery, you will need to follow these precautions after spine surgery for approximately 6 weeks to 3 months.
- Reposition frequently from sitting to standing to walking during the day avoiding prolonged sitting for more than 1 hour.
- If you are given a C-Collar to wear after surgery, you should be expected to wear it for approximately a week. BE SURE TO ASK YOUR DOCTOR AT DISCHARGE.
- Walk as much as possible increasing distance and/or time slowly but surely.
- You may work but may need to have restrictions for up to 6 weeks as far out as 3 months from surgery depending on what your doctor tells you at your 1 month follow up visit. Ask your doctor upon discharge WHAT your restrictions are until you return to us at your 1 month Post-op visit.
- DRIVING RESTRICTIONS: You should not drive the first 2 weeks after surgery due to your healing and being on pain medicines that can make your drowsy. After beginning to wean your pain medications and you feel capable to maneuver a vehicle without excessive “BLT” then you should be fine to drive. Some exceptions include neck surgeries where you should not turn your neck to allow healing and fusion of your new hardware.
Remember: No BLT (Bending, Lifting, Twisting)
- Bending – Avoid bending. No squatting if you had surgery that extends to the lower back
- Lifting – No lifting over 5-10 pounds.
- Twisting – Avoid twisting motions. Always turn your entire body in the same direction.
Pain Management
- It is normal for you to feel some level of neck/back soreness and/or stiffness after surgery, especially if you had a spinal fusion. Applying ice packs, warm compresses, & taking muscle relaxants such as Baclofen & Flexeril (as ordered) can offer pain relief. You will be given some form of pain management medications after surgery that should be weaned by your 1 month post-op appointment. These medication prescriptions will be given at time of discharge and cannot be given before.
- Your nerves can get irritated from being moved around during your spinal procedure, so it is not uncommon to feel numbness and tingling after surgery. These symptoms should improve over time.
- Stay ahead of your pain. Do not wait until your pain is severe. Take your pain medications when you need them but not more often than directed by our team. It may be helpful to take them prior to Physical therapy sessions or when you anticipate being more active.
- Take your pain medications only as directed. Please contact your surgeon’s office if your pain is not adequately controlled.
- You will not always automatically have 100% pain relief after surgery. Please understand surgery is not an “end all/fix all” answer to your pain. You are likely to have some discomfort even after your surgery for possibly weeks up to months after surgery. We are always hopeful that your surgery does help reduce most of your pain/discomfort.
Managing Constipation
- If you are taking pain medications, be sure to take your ordered medications to prevent constipation (such as Colace, Dulcolax or Miralax). These medications are available over the counter at most pharmacies/drug stores.
- Be sure to drink 6-8 glasses of water per day to stay well hydrated and prevent constipation. Limit caffeinated drinks to 1-2 cups per day.
- Eat plenty of fresh fruits & green vegetables to prevent constipation. Brown rice, legumes/beans, high fiber cereal, oatmeal, granola, and whole grain bread are also good options.
- If you have not had a bowel movement in 3 or more days, please call your surgeons office right away. You may need to use a fleets enema, suppository, or Magnesium Citrate (which are available over the counter) so that you can have a bowel movement.
Wound Care
Check the incision daily for signs of infection. Contact your doctor’s office immediately if you have any of the symptoms below:
- Fever over 101° F
- Redness and/or swelling at the incision area or opening of incision area
- Pus, bad smelling drainage, or pain at or around the incision area
- Flu-like symptoms (chills, body ache, etc)
Dressings
- Keep the dressing on your incision clean and dry.
- Change the dressing if your surgeon told you to daily or if it gets wet or soiled until NO drainage for 48 hours then you may leave it open to air.
If you do change the dressings:
- Wash your hands well with soap and water before touching the dressings.
- Remove the dressing carefully. If you need to, soak some of the dressing with sterile water or saline to help loosen it. Do not use tap water.
- Apply a new dressing, most commonly 4×4 gauze pads and secure with tape.
If you have skin glue
- Skin glue appears white, dry, and crumbly. Sometimes it is brown and crumbly.
- The skin glue will gently break down and crumble off your skin, leaving it healed underneath.
- Cover the dressing with gauze and tape for 1 week after surgery
- After 1 week, you may remove the dressing and leave the incision uncovered.
- Avoid getting skin glue wet for 7 days (unless instructed otherwise by your surgeon).
- Do not scrub off the skin glue.
If you have Staples or Sutures in your Incision
- Depending on your surgery type and how quickly your wounds heal, staples/sutures may be removed between 10-21 days after the date of surgery.
- Keep the incision dry while staples/sutures are in place and 24 hours after they are taken out.
- Do not use cream, lotions, or ointments (including antibiotic ointment or cream) on the incision while sutures or staples are in.
- Incisions can be cleaned with normal saline.
- Your primary care provider or home physical therapist/nurse may remove the sutures/staples if appropriate, or you may have them removed at our clinic.
- Steri-strips or butterfly strips may be placed after the removal of your staples or sutures. These should remain on until they fall off by themselves.
If you have Steri-strips:
- Steri-strips are small pieces of paper stitches that cover the incision and protect it. Under the steri-strips, the incision has been closed by dissolving sutures which do not need to be removed.
- If the steri-strip edges curl up over time, you can trim the edges off; otherwise they will fall off on their own. If the steri-strips are still on after 14 days, gently remove them.
- You may cover the steri-strips with gauze and secure with medical tape. After the steri-strips have fallen off or are removed, you may leave the incision uncovered.
Showering
- Incision should remain covered while showering for at least 7 days after surgery.
- Cover the dressing with Saran wrap or freezer bag while showering if desired. Use medical tape to tightly secure the edges to prevent water entry. Medical tape can be purchased at any local drugstore.
- Change the dressing immediately if it becomes wet.
- After post op day 7 when showering please clean incision gently with mild soap and warm water and apply dressing after, if needed.
Incision Pain
- It is normal to have some discomfort or pain at the surgical site during activity and at night for a few weeks after surgery.
- Using an ice pack for 10 to 15 minutes may relieve pain at the surgical site.
- Take your pain medication as instructed by your doctor.
- Call your doctor’s office if the pain gets worse or does not go away as expected.
Orthopaedics Spine Pain Medication Policy
- We encourage and expect every patient who has been scheduled for surgery to have recently seen their primary care physician within 3 months of the surgery date.
- We will only prescribe pain medications at hospital discharge and first follow up appointment (4 weeks post-op). For our larger procedures this could differ.
- We do not prescribe narcotic pain medications to patients who have not undergone surgery with us. Depending on your surgery, you may be prescribed Narcotics, muscle relaxers and nerve pain medication along with stool softeners. Take as directed!
- Narcotic pain medications prior to surgery should be prescribed by either the patient’s primary care physician or by a pain management doctor. Other forms of pain management prior to surgery can include Tylenol, Lidocaine patches (Over the Counter), topical pain creams.
- If a patient currently has a pain management physician, they will be referred back to them after surgery, preferably within 30 days after surgery to optimize the post-operative pain management protocol.
- Please call 2-3 days in advance of running out for medication refills to be sent.
