How long in hospital after surgery?

[C2WAVE2]

Mpbser. Good luck. I was wondering how long as well. Sure it varies quite a bit.
With different cases.
I'm scheduled fore surgery on the 23 rd. Resection near rectum junction, with
Temporary bag. My Dr. Said I would be in hospital 3 to 5 days, but
Guess that is, if everything goes well.. Sure is scary thought..

Thanks heyday, I am very active with sports and want to get back as quickly as possible, but
Not mess up the healing process...
Take care all, Chuck

[John72]

LAR - 7 days I believe..the lady in the room next to me had the exact same surgery. She was older than me by about 12 years(still meaning she was under 50) and would not get out of bed. I could hear her kids pleading with her to get out of bed but she wouldn't budge. When I was discharges on day 7, she was going on day 18.

It does vary. As soon as you can walk start doing so, even if its just a few steps. It hurt quite a bit...I was tapping on the morphine as soon as every ten minutes was up...but I was on fairly long walks around all the hallways on the floor by day 4, about 4-5 times a day. One doctor on the floor, who was not my doctor, said that if everyone walked as much as I did, they'd never lose a patient.

[Jacques]

In my opinion, the length of hospital stay depends in large part on what the anesthesiologist administers during the operation and then on what the patient does in the post-operative recovery period to flush out these toxic anesthesia agents.

The article below gives an overview of the profound complexity of the anesthesiogist's job.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339719/
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My anesthesiologist gave me a very condensed overview of the process and mentioned the role of the different agents used by the anesthesiogist during the operation. One of these agents of course is General Anesthesia (usually Propofol), which is excreted very quickly after the operation is over, thereby allowing the patient to regain full consciousness in just an hour or two. Another agent, however, is the regional muscle relaxant used to immobilize the bowel so that the surgeon can do his/her work. Apparently, this agent takes a much longer time to be excreted from the body. The muscle relaxant agent is a large molecule drug that doesn't pass easily or quickly through the membranes. This may be is why it helps to walk a lot in the post-operative period -- walking helps work the toxins out of the system. If you don't walk or move around, then the toxins just stay there and the bowel remains paralyzed. Sometimes this state lasts for a long, long time and is called "paralytic ileus"-- i.e., a state of paradoxical paralysis of the bowel. It should also be noted that if the patient uses the morphine-based pain pump a lot just after surgery, then this will likely have the effect of prolonging the paralysis of the bowel even longer and therefore will likely delay the patient's discharge from the hospital. In other words, the more you use the pain pump, the longer it will take for your bowel to recover and for you to pass gas and to have normal peristalsis movement in the bowel,

Here is another web page you might want to have a look at. It concerns research sudies on laparoscopic colon resections.

Laparoscopic colonic resection studies
http://www.postoppain.org/sections/?root_id=63528&section=13

Here is an Informed Consent template explaining the risks and benefits of anesthesia

Consent Information - Patient Copy -- About Your Anaesthetic
https://www.health.qld.gov.au/consent/documents/anaesthetic_01.pdf:

And here is a web page giving a list of cardiac risk factors for abdominal surgery patients.

Cardiac Risk Index for Abdominal Surgery
http://reference.medscape.com/calculator/cardiac-risk-index-abdominal-surgery

[mpbser]

Thanks again everyone. Thanks for the very handy information. My wife is printing it out now to bring with us on Friday.

[benben]

Thanks again everyone. Thanks for the very handy information. My wife is printing it out now to bring with us on Friday.

Good luck to you Friday. I go for blood draw/chemo consultation on Friday.
As for my hospital stay - the surgeon said I could go home after 3 nights at the hospital, but I opted for 1 more day because I had a drain in place.
I only took the meds they gave me daily for nerves/pain and used nothing else - no morphine. Even used nothing after I was sent home.
Also i walked - alot. They had me up the same night as surgery to do my first walk. Surgery completed 6pm.
By 8pm I was asleep and at 11pm the nurse came in and woke me up to take that walk. I did one half loop.
Next day they wanted me to start walking 6 times around the floor loop each day. I did the 6 first 2 days then upped it to 8 on days 3/4
Walking really does help, 4 weeks since my LAR and I walk 2-4 miles each day depending on how much time I have.

[JudeD59]

I had an open LAR with a temp ileostomy. I had to be cut from above belly button to groin because of adhesions. The surgery was Wednesday morning and I was discharged Friday morning. I was originally told I would be in until Monday at least. This was my fifth abdominal surgery. Some people don't mind staying in the hospital longer because they like having the doctors and nurses watching over their progress. I hate being in the hospital because I can never sleep with all the people coming in to check you and the machines beeping and buzzing, so my goal is always to be released as soon as reasonably possible. The minute they give me permission to walk around, I walk, usually within the first hours after being brought to my room. I stand straight and tall, not hunched over, and I walk the halls at least once an hour all day long. I make sure I pass the nurses' station so they can report back to the surgeon on my progress. Getting out of bed is the most painful part, but walking actually gets your digestive system moving and makes you feel stronger and less achy. And the more you get out of bed, the less the actual getting out of the bed hurts.

With all my surgeries except one (emergency bowel resection for complete obstruction) I've had the surgeon say, "I've never let a patient go home this quickly, but you are doing so well, I'm going to send you home." As soon as they let me drink something, I ask for cranberry juice, which helps get the bladder working. I also try to eat as much of the "delicious" hospital food as I can get down.

This isn't meant to be a boastful "I get out of the hospital quicker than you" kind of post. For me personally, I know from experience that as soon as I get home I'll take a long uninterrupted nap and feel 20 times more human than I did in the hospital, so I'm just passing on tips that might help you get home sooner if that is your goal. I also have back problems which are much worse in hospital beds so I'm better off on my own mattress. Again, this is just my personal preference and experience. Not everyone is as anxious as me to leave the hospital.

I also strongly recommend having a family member or friend stay with you while you are in the hospital if at all possible. I've always had my husband or one of my daughters with me round the clock in the hospital and I've done the same for them. Just having someone to help you to the bathroom or hand you things or to be an advocate for you when you are feeling weak and vulnerable is an amazing advantage. Anesthesia and pain meds can make you fuzzy and forgetful. It's great to have someone with a clear head to remember what the doctors say and when it's time for more pain meds. And the nurses like when you have help because you don't have to call them every time you want ice water or help putting your robe on or someone to walk the halls with you. They will usually provide a recliner, pillows, and blankets for your advocate so they can get some sleep.

Good luck and I hope all goes well!

Judy

[mpbser]

Thanks again for the new comments.

I faxed the following to the anesthesiologist today. The nurse called me back and said that the doctor will call me tomorrow. She did answer one of the questions I had. They do not use epidurals at all for this type of procedure, open or not. That's interesting because from the journal article it sounds like it is standard for open surgery colectomies.

PRE-SURGERY QUESTIONS FOR ANESTHIOLOGIST

First, before I get into my questions, I want to make note of a couple things:

• First, my records at svhealthcare.org have varying notation about the local anesthetic I have adverse reaction to. It is any local anesthesia that contains epinephrine.
• Second, I have a varicose vein in my right calf that has worsened over the past month. That fact is not in my records.

The following questions have been derived from Anesthesia and perioperative management of colorectal surgical patients – A clinical review. J Anaesthesiol Clin Pharmacol. 2012 Apr-Jun; 28(2): 162–171. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3339719/

1. Do you plan on doing an epidural? At what block height? I am not sure how likely conversion to open surgery is, but I know from Dr. Cope that it is a possibility. The journal article recommends inserting an epidural catheter if conversion to open surgery is likely. The article also reports that intraoperative thoracic epidural anesthesia and analgesia has been associated with an increase in colonic blood flow and better gastrointestinal recovery.

2. Continuous spinal anesthesia using microcatheter is used for high-risk patients. Although Dr. Rogge noted in his cardiac catheterization report that I will likely tolerate the surgery well, I am not exactly a “low risk” patient due to:
* BMI of 35,
* hemoglobin ranging from 7 to 9 (his last transfusion was 4/12/17 and CBC on 5/2/17),
* low hematocrit,
* elevated NTproBNP,
* hypertension,
* 40% occlusion at 1st septal perforator of LAD,
* low left ejection fraction of 40%,
* diffuse dilated cardiomyopathy,
* diffuse hypokinesis and diffuse reduction in wall thickening in LV wall,
* high blood glucose/diabetes, etc.
The article notes that a wide variety of CR surgical procedures are performed with anesthetic block height T6-T7. After establishing spinal anesthesia with heavy 0.5% bupivacaine and fentanyl, 0.5% isobaric bupivacaine was used to extend spinal anesthesia. However, the microcatheter was removed at the end of surgery. If this is something that will be done, what exactly is planned?

3. What specific anesthetic or analgesic agents are planned for laparoscopic surgery? For open? If the surgery gets converted from laparoscopic to open, will there be a need to change anesthesia to address the change?

4. Will you use neostigmine aka Prostigmin? I hope not.

5. What is planned for goal-directed hemodynamic management?

6. Will you be monitoring central venous oxygen saturation (ScvO2) intro-operatively and post-operatively?

7. Will you administer dopexamine? If so, at what dosage mcg/ kg/min?

8. Will restrictive fluid therapy be used during the postoperative period?

9. Is a “nil by mouth” until flatus has been passed or bowel sounds heard strategy planned?

10. How many hours post-surgery will enteral nutrition be allowed?

11. What post-operative pain management is planned if the surgery is laparoscopic? Open?

[tarheelmom]

A very good friend of mine is the chair of the anesthesiology department at a major university hospital. When she described everything she does during surgery, I was astounded. I participated in the ERAS (Enhanced Recovery After Surgery) protocol which was led by the anesthesiologist. While I had some discomfort, I did not take any opiod based narcotics. I was on a cocktail of Tylenol, Lyrica, and Celebrex. I didn't need anything after the 2nd day. Surgery was on a Tuesday. Started walking on Wednesday morning. Home on Saturday only because I needed additional time to learn how to manage my ileostomy. By Sunday I was at Costco and doing laundry. I thought the ostomy takedown was a more difficult recovery than the resection. Maybe because after the take down, there was a lot of urgent running to the toilet. Good luck.

[Jacques]

...The nurse called me back and said that the doctor will call me tomorrow...

When you talk to your doctor tomorrow, please try to be pleasant, and not abrasive or confrontational. I think you can get much better support if you are nicely aassertive when communicating with your doctor.

Reference:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184

[mpbser]

Tarheelmom, thanks for the heads up about that combination of medications. I do have concerns about Celebrex, but I suppose that I can use it for a very short term without adverse incident.

[Jacques]

Another thing you might want to check on before Friday is the plan that they have for cross:matching your blood with available transfusion units at your hospital:
Are they expecting to need transfusions during your surgery, and if so, how many pints of blood are they planning to pre cross-match? The full, major cross:match process takes about an hour for each unit, so I think it needs to be done before the surgery.

In my case, the surgery lasted twice as long as expected, and the 4 units of blood that they had cross-matched for me was not enough so they had to quickly find some universal-donor non cross-matched blood to finish the operation. This was a less-than-desirable situation because the extra units of blood that I got may have come from a donor who had some problem such as lactose intolerance, gluten intolerance, glucose intolerance, etc. - - - something to consider.

[mpbser]

Thanks, Jacques. Yes, I do have appointment scheduled to get cross-matched and have another CBC Thursday morning.

On a side note, I am concerned about the chances of having to convert from laparoscopic to open surgery. My CT showed "irregular protrusions posterior medially which is concerning for tumor invasion into the pericolonic fat." Does this mean that the surgeon might have difficulty doing the separation laparoscopicly due to pericolonic invasion? My surgeon was very ambiguous on this issue. What has others' experiences been?

[Stewsbetty]

My surgery (right hemi colectomy) started laparoscopically but then they needed to open me up to achieve clean margins on the posterior. When we got the results the surgeon was most excited by the 1cm margins on the backside than the 15-19cm on the sides. Doing much of the procedure laparoscopically allowed for a smaller open surgery cut - it was only about 4-5 inches. The surgeon told me for a regular open surgery the cut would be much longer.
Regarding all the advice about walking, don't beat yourself up if that doesn't happen as quickly for you. I had to walk the day after surgery as I had to change rooms. There was no way I wanted to sink down into a wheelchair (I am tall) and then have to stand, so I shuffled down the hall to my next room. Other than that I didn't do any walking until the catheter bag was removed after 2 days. I went home after 5 days I believe.
Good luck with your surgery and try to mentally relax as much as possible.
Beth

[KimT]

Doctors spend 4 years in undergrad, 4 years in medical school, 4 years in residency, and 3-5 years in fellowship. Finding outdated articles and misinterpreting the data and using Wikipedia as a source is an insult to the decades spent in school and training by doctors.

Blood is never given without cross matching it. There are strict policies in place at every hospital with regards to blood transfusions. They do not stray from those policies. Ever. The way it works is when you are typed and cross matched, they will cross match 2 units (or more if specifically ordered, otherwise 2 if no quantity is stated on the order) Those 2 specific units will be set aside for you and only you. If they are needed, they are released immediately as they have already been cross matched. If they aren't used, they go back into the pool of available units to be cross matched for other patients. After 3 days, you have to be cross matched again as a type and cross match is only valid for 72 hours. In an emergency cross matching can be done faster by using universal blood types O- and O+. Furthermore, gluten sensitivity, lactose intolerance, etc does not exclude anyone from giving blood and is not a consideration when cross matching.

Much of your treatment is out of your control. Focus on the things you can control. The best thing you can do is get moving and walk after surgery. Our Eric once gave some brilliant advice about how to get what you need and want from the nursing and physician staff while in the hospital. Don't be a pain in the ass, don't waste their time, and cooperate. As someone who has been on both sides of medicine as a nurse and a patient, this is the best advice I have ever heard.

[mpbser]

Where is a wikipedia citation? Where is any misinterpretation? Why are questions insulting? I want to understand all aspects of the procedure and recovery. This is my body and I firmly believe in informed consent. Is there a problem with wanting to be informed? I really don't get the point of this part of your post.

I've had six transfusions to date. I know that blood is never given without cross matching it. I had an allergic reaction to one of the units. Cross matching this time won't be done only for blood type, but for antibody screening and other purposes according to the anesthesiologist.