Generally you will be admitted to the hospital on the day before the surgery, this to allow any tests that need to be done again, and for the review with the anesthetist. Our staff will let you know what you need to do and when you are required to present to the hospital.
Pre-operative – During Your Hospital Stay
Where to go on the day of surgery?
On the day before surgery you are required to present to the admission office in the hospital with your referral for admission (RFA) note, insurance card, pre approval letters if any (if claiming cashless insurance) and any imaging films (x-rays) you have with their reports. You will hand all these documents to the person in the admission office and they will process your papers, which can take few minutes. After the paper work is done you will then be directed to your hospital bed. Depending on the hospital you are admitted in Dr.Aditya Khemka may pay you a visit either in the admission area, the ward, the pre-op area or the holding bay. When he sees you he will ask you few questions, which may sound as if he is meeting you for the first time, however, this is just to ensure everything is correct. These questions are very important and they are part of our protocol to avoid any mistakes regarding the site of surgery.
- What surgery are you having today?
- Can you please point to the limb we will operate on?
- Can you show me the area we will operate on?
- Do you recognise your signature on the consent form and are you consenting for this procedure?
- Do you have any questions Then after these questions, Dr.Aditya Khemka or one of his assistants will mark the area to be will operated on with an arrow and initial name using a permanent marking pen.
What happens in the hospital before surgery?
Once you arrive on the hospital ward you will be taken to your designated bed and one of the nursing staff will assist you with getting changed into a hospital gown. The nurse may ask you few more questions and will take your vital signs including blood pressure and temperature.
Sometimes your anaesthetist will pay you a visit to ask further questions and perform an examination to make sure you are ready for the operation. After all the necessary procedures are done you will be asked to rest while waiting to be taken to the operating theatre. We do our best to minimise the time that you have to wait. However, sometimes it may be difficult to be precise since there are many factors beyond our control such as the complexity of the surgery being completed ahead of you. We appreciate your understanding and patience.
What happens during surgery?
Once the theatre is ready for you, a member of the theatre staff will come to escort you in the bed to theatre. A member of your family may accompany you to the outside door of theatre but beyond this point is only staff access unless the patient is a minor and needs an accompanying parent.
Depending on what hospital you are in, you may be taken to the pre-op unit or to the holding bay in theatre where a member of the staff will receive you and your papers and may ask you few more questions similar to the ones asked earlier. The staff member will double check the site of surgery and the consent form. This multiple checking is vital to ensure that you receive the best outcome and your patience is appreciated.
The anaesthetist and his nurse or technician will come to see you and take you to the anaesthetic bay where monitor cords will be hooked up to your chest and limbs and a blood pressure cuff placed on your arm. They will also insert one or more intravenous access tubes through which you will receive medications and fluids. You will be given a dose of prophylactic antibiotics to decrease the chance of infection as well as premedication drugs, which will make you drowsy. From this point onward you will be regarded as under anaesthesia and will not be asked any more questions. You will either be given a spinal, epidural or general anaesthesia. You and the anaesthetist will make this decision together taking into account several considerations such as your medical condition, type of surgery and other contributing factors.
Once you are under anaesthesia a urinary catheter may be inserted if needed and you will be positioned in the most appropriate position for the surgery. Using a disinfectant solution we will prepare the area of surgery and then apply sterile drapes to isolate the area from the surrounding environment. We practice a complete sterile non-touch technique to minimise the possibility of infection.
The operation will be performed with the help of one or two surgical assistants who are usually medical officers experienced in assisting, or orthopaedic surgeons in training. A scrub nurse, one or more scout nurses and in the case of joint replacement surgery, a representative from the company that provides the implant we will be using will also be present. All the staff involved in your operation are professional and experienced in the field of orthopaedics. Every member of the team plays a vital role in ensuring the success of the procedure.
We strongly believe in minimal handling of tissue and in using the latest evidence based surgical techniques in an efficient manner. This means each surgery will involve the smallest possible wound, proper identifying of the pathology, performing an accurate procedure, non-touch technique, minimal dissections of soft tissue, efficient time utilisation in order minimise blood loss and decrease morbidities, anatomical closing of deep wounds and cosmetic closing of the skin. For information about individual procedures please review the corresponding sections found on this website.
Once the wound is closed, a sterile dressing will be applied and the sterile drapes will be removed. If a general anaesthesia has been used, the anesthetist will start the process of waking you. You will then be transferred to the recovery room where one of the recovery nurses will receive you. The recovery nurse will ensure that you have sufficient pain control, observe your vital signs, monitor your blood loss from the drain and make sure you are fully awake before you are transferred back to the ward to your bed. The process in recovery takes about one hour. Depending on what hospital you are having the procedure in, a post-operative X-Ray may be performed before you leave theatre especially if you have had a joint replacement surgery.
The operation time will vary depending on the complexity and type of surgery and can range from one to three hours. However, the whole process from getting to the holding bay till you are back in the ward may take several hours, so please reassure your loved one that it is not unusual for the process to take a considerable time.
What happens after surgery?
The average hospital stay after joint replacement is usually three to five days. The vast majority of people who undergo joint replacement surgery will experience a dramatic improvement post-surgery. This improvement is most notable one or more months after surgery. The pain caused by the damaged joint is relieved when the artificial joint is implanted during surgery.
With other conditions such as fractures, patients will notice an improvement of pain but in a slightly different way. One has to remember that fracture patients are a completely different category of patient and complete fracture healing can take weeks and sometimes months.
The day of your procedure and the following day, the nursing staff will keep close observation of your vitals as well as fluids input and output. Depending on the hospital policy family members may pay you a visit and Dr. Aditya Khemka will also pay you a visit and check how you are doing.
As a general rule we recommend that mobilisation should be commenced as soon as possible. On the first day after surgery you will be visited by the hospital physiotherapy staff who will aid you to get out of the bed and start mobilising according to our recommendation. One the same day the nursing staff will remove the drain tube if there is one.
Once you feel comfortable and confident enough to use the toilet the nursing staff will remove the urinary catheter if you have one. This usually occurs in the first or second day following surgery.
Throughout the next few days following surgery the physiotherapists will visit you on daily basis. At first you may walk with the help of parallel bars and then a walking device such as crutches or a walker will be used until you are able to support your full body weight. Once you are mobilising safely and you feel well enough, then you will be discharged home. This may vary based on the complexity of the surgery and your general health.
Most patients are walking comfortably with minimal assistance after about six weeks and once muscle strength has been restored with physiotherapy.