Patient Surgical Guide

The prospect of brain surgery or spine surgery can be a daunting one. We understand that you may feel scared and apprehensive as your surgery nears. On the other hand, many people also feel relieved and hopeful–and rightly so. You’ve made the decision to let us help you get better.

We’ve assembled this surgical guide to help you and those helping you with your treatment recognize, address, and prepare for the events that will happen before, during, and after your neurosurgical procedure.

Important Phone Numbers

Barrow Brain and Spine Appointments: (888) 779-0441
St. Joseph’s Hospital Main Number: (602) 406-3000
Registration: (602) 307-2305
Preoperative Center: (602) 406-3192
St. Joseph’s Hospital Concierge Services: (602) 406-3970
St. Joseph’s Hospital McAuley Pharmacy (602) 406-3970

Hospital Registration

Registration can be completed the morning of surgery or in advance by calling (602) 307-2305 or by visiting St. Joseph’s Hospital website.

Diet

In the weeks before your surgery, begin eating a balanced diet if you are not already doing so.

Include protein and dairy in each meal.
Eat 3-4 meals per day

Decrease your intake of alcohol, caffeine and cigarettes weeks or months prior to your surgery if possible. It is not recommended that you abruptly stop smoking days before surgery. Doing so can have an adverse affect on your breathing passages.

Medications

Notify your surgeon if you are currently taking the following medications:

hypoglycemics (insulin or oral agents)
anti-coagulants/anti-platelets such as Aspirin, Excedrin, Coumadin, Plavix, Heparin, Lovenox, etc.
anticonvulsants (Depakote)
anti-inflammatory drugs including Anaprox, Dolobid, Feldene, Motrin, Ibuprofen, Naprosyn, Toradol, Vioxx, Aleve, Advil, etc.
natural supplements such as Vitamin E
herbal medications such as gingko and St. John’s wort

Your surgeon may ask you to discontinue some medications before surgery because many of these substances contain ingredients that interfere with normal body functions and can increase the risks of complications during surgery.

Planning

Plan your discharge ahead of time:

Identify a companion to help you for a few days after you arrive home.
Arrange transportation to and from the hospital. Discharge usually takes place by 11:00 AM.
Stock your refrigerator.
Prepare meals in advance.
Contact your insurance company to determine your benefits regarding outpatient therapy or medical devices such as walkers and shower chairs that you may need once you are home.

Preparation

Remove nail polish, jewelry, and body-piercing jewelry. Your surgeon may request that you take a shower with Chlorhexadine the night before and morning of surgery, from the neck down, giving special attention to the area of surgery. If you are scheduled for head or neck surgery, you may also be asked to shampoo your hair with your shampoo of choice when you shower as instructed above. Do not use hair spray, other styling products, lotions, or perfumes. Underarm deodorant may be used unless you are undergoing a thoracoscopic procedure for hyperhydrosis.Traditionally, patients are advised not to eat or drink at least eight hours prior to their surgical procedure. Please consult your surgeon for the restrictions that apply to your specific case. Specific guidelines are given to children based on their age, body weight, and time of surgery. Always remember to consult your surgeon for specific instructions.

Parking

The closest parking for surgical patients is in the 6th avenue garage. Additional parking may be available in the 3rd avenue garage. Upon request, hospital security will escort you to your car and may be available to shuttle you to and from nearby hotels. Valet services are available from 6:00 a.m. to 8:00 p.m. Fees for valet services as well as the parking garage are available at the hospital information desk.

Arrival

The morning of surgery you will arrive in the Preoperative Center at 5:00 a.m. (unless directed otherwise by your surgeon). This department is located on the 2nd floor of the neuroscience tower.

Do not bring the following items to the hospital:

Unnecessary valuables or jewelry
Medications from home. Hospital policy prohibits patients from receiving medication from outside the hospital for safety precautions.

Do bring the following to the hospital:

complete list of medications that you take at home, including dosages and frequency
insurance card and means to pay hospital co-payment
identification
living wills and advance directives
test results

If you have had a chest x-ray within the last year, notify your surgeon to avoid unnecessary testing the morning of surgery. Also tell your physician if you have had an EKG (electrocardiogram) test completed within the last month. Your surgical team will want to see the results of this test. Give these documents to your surgeon’s office before surgery or bring them with you the morning of surgery.

If you have experienced any medical challenges such as cardiac, renal, or respiratory conditions, please make sure that your specialist is aware of your upcoming surgery. These physicians must “clear” you for surgery; that is, they must provide a written release stating that your condition does not prohibit you from undergoing surgery.

Preoperative Center Services

Once you are admitted to this department, various tests and examinations are performed:

Blood is drawn unless you have been pretested or have copies of results from an outside laboratory.
A nurse checks your vital signs (blood pressure, pulse, temperature). Procedures may be cancelled if you have a fever and other symptoms of illness.

Please notify your surgeon’s office if your temperature is higher than normal or if you have other symptoms of illness before the day of surgery. You may undergo x-rays, CT, or MRI studies before your procedure on the day of surgery or in the days leading up to it.

Before Surgery:

You will change into a hospital gown.
Your clothes will be given to your family.
An identification bracelet will be placed on your arm. You will wear the bracelet until you are discharged from the hospital.
You will be asked to sign registration and consent forms for your surgical procedure and for any tests, examinations, or consultations that your surgeon orders while you are in the hospital.
You may be examined by a physician to assess your general health and to diagnose any unexpected illnesses.
You will be asked to remove your eye glasses, contact lenses, and dentures. Your dentures may be placed back into your mouth in the recovery room when you are awake and alert.
You will be asked to remove all jewelry.
Hearing aids will not be removed until you have arrived at the operating room to ensure that you can communicate with the surgical team until you drift off to sleep.

Before Anesthesia:

You and your family will be welcomed by your anesthesiologist and registered nurse from the operating room.
You will have an opportunity to ask questions about the procedure and recovery process.
An intravenous catheter may be placed in your arm to administer medication to relax you before you are taken to the operating room.
The surgical site will be shaved if necessary once you are asleep in the operative suite. The amount of hair to be shaved is determined by the type of procedure and by your surgeon’s preference. For most cranial (head) surgeries, a small “strip” is shaved over the surgical site, rather than a full head shave.

Your family will be notified once you are transferred to the recovery room from the operating room and again when you are to be transferred to your room. Visitors may be permitted in the recovery room at the discretion of the recovery room staff. You will remain in the recovery room for about an hour while you are waking up from anesthesia.

The nurses monitor your neurological status and vital signs. You will be asked to state your name and to answer other questions to assess your mental status. You will be connected to a cardiac monitor, pulse oximetry machine (measures the oxygen in your blood), temperature gauge, and oxygen mask. Pain medication is available to you as ordered by your surgeon. Our team is strongly committed to pain management. Please notify your nurse if your pain is not adequately addressed. Because many patients feel nauseated after a surgical procedure, medications are given in the recovery room to help prevent this unpleasant side effect.

You may have a variety of intravenous and arterial lines, which may remain in place for a few days or until hospital discharge. Flexible catheters may be used to drain surgical sites, the bladder, and brain fluid called cerebrospinal fluid (this tubing may be located in your lower back or top of your head). These drains may remain in place for as long as 4 days and are removed at the discretion of your surgical team.

Sequential compression stockings are placed on your legs to assist blood flow to your heart during surgery and while you are immobile. Surgical dressings depend on the procedure and surgeon. Many cranial (head) surgeries do not warrant a dressing. Rather the site is kept clean and may be treated with antibiotic ointment.

Medication may be ordered to control your pain and to assist in your recovery process. Please ask for this medication when you feel uncomfortable, especially during the first few days after surgery. If you wait until the pain is extraordinarily strong, the medication ordered by your doctor may not be able to control your pain. If you are concerned about becoming dependent on narcotics, please discuss this fear with your surgeon before surgery. Non-narcotic medication is available and is often sufficient to control pain.

Intensive Care Units (ICU)

The hospital has many different ICU(s). You will be assigned to a specific ICU when you enter the recovery room. ICU(s) are available to patients who require close monitoring such as those recovering from a surgical procedure or who are critically ill. In this department there is usually one nurse for every two patients. Visiting hours vary among the different ICUs. Flowers and live plants are not permitted in these areas. Please check with your unit for specific policies.

In the ICU you will be encouraged to increase your activity level as tolerated to help avoid complications associated with temporary immobility such as gas pains, bed sores, decreased lung capacity, and blood clots. You will be asked to reposition your body, to take deep breaths, and to use an incentive spirometer to flush anesthetic agents from your lungs. Showers are permitted after your surgeon provides a written order. Your nurse assesses your neurological status at predetermined times to ensure that you recover as expected. Your assessment includes being asked various questions to test your alertness. You also may be asked to move specific parts of your body.

Food and liquids are introduced slowly, beginning with ice chips and advancing to more substantial foods as tolerated. Tests such as radiographic studies (MRI, CT) and laboratory tests may be performed in the days after your surgery. At this point, you may need treatment to assist with your recovery such as speech, occupational, and physician therapy. These services may continue throughout your hospital stay and after hospital discharge in an outpatient setting. Social work, case management, and pastoral services are available on request.

General Nursing Units

Once close monitoring is no longer required, you will be transferred to the general nursing floor. Private and double rooms are available in these areas.

On General Nursing Floors:

Your activity will be increased to avoid muscle weakness and other complications of immobility. Some patients are out of bed the same day as surgery.
Services such as physical therapy, speech therapy, and rehabilitation may be provided.
As your level of activity increases, your discomfort may also increase.
At this point pain, medication is usually taken orally rather than through an intravenous line.
Diet is advanced as tolerated. Small, frequent, balanced meals will help you heal faster and regain your normal energy level.

to learn more

Patient Surgical Guide