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How long in the hospital after surgery?

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Jean3600

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Hi, I'm new on this site...have been lurking reading your comments and following your experiences. You are all heros and the most generous cheerleaders I've come across!!

I am scheduled to have TKR on my right leg September 12th at Kaiser Hospital in northern California. My orthopedist said he does the surgery with a spinal block and "twilight" sleep. I am overweight so I guess this is better than general anesthetic. But my real question to all of you is: you all seem to be in the hospital for 2-3 days. My doctor said that I would be in the hospital overnight (almost like an outpatient surgery). Have any of you had that experience? I'm going through this by myself as my husband has passed away. So the more information I can get, the better prepared I can be.
 

Jamie

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@Jean3600 .... you'll notice I have moved this post of yours to a new thread in the preo-op forum as it is more appropriate here. You had posted in someone else's recovery thread and that can tend to take the discussion off topic. As long as you are still awaiting surgery, you can start as many threads here in pre-op as you like with different topics. Be assured that lots of people who have had surgery routinely check the pre-op forum and respond to people who are awaiting surgery. You'll get lots of responses.

Now, about your question on length of time for the hospital stay.....it's a matter of whatever the surgeon prefers. Many do keep people in hospital 3 days. But some do shorter stays. There is generally a move within the medical community toward shorter stays. While some of this may be driven by rising costs and insurance company policies, it actually is possible because of improved surgical techniques and better pain management protocols.

An overnight stay is not a given, though. Your surgeon will not send you home if you are not ready to go. Your part in the process will be to discuss any concerns you have about your stay with him BEFORE your surgery and to actively communicate with him following surgery if you are not prepared to go home and be by yourself. Most critical is to be sure your pain is properly managed before leaving. You should be able to get yourself up, to the bathroom and back to bed or a chair with no assistance.

You should have an option to go to a rehab center if you so not feel you will be safe at home. Sometimes you must be a bit assertive if you want this option. The keys words to tell everyone involved with your care is that you don't feel safe going home alone. Check out some rehab centers before your surgery so you know where you would like to go if necessary. Some facilities are just glorified nursing homes and that's not what you want or need. Go unannounced and ask for a tour. Look at rooms and check out therapy rooms.
 
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Jean3600

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Jamie, thanks for moving me to an appropriate place and for your response to my questions. I will post on an appropriate place starting my own thread. I have just not read anywhere (so far) that patients were released within 24 hours of surgery. Kind regards and thank you again.
 

Jamie

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Actually we have had a couple of members who were released after an overnight stay. I don't know how I'd feel about that, though. I believe the three days in hospital was just right for both of my knee replacements. With my surgeon, I had the option of saying when I was ready to go home. I guess not all doctors and hospitals (and insurances) are like that, but I still think you will have some say in the matter. They don't just toss you out on the street once the surgery is done!
 

PolarBear60

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We have had people go home the same day! I'm aghast at the very idea, but the few people who have done this seem happy with their results.

For both my knees, I had the surgery on Tuesday morning and was discharged to home on Friday. For my second knee, I was ready to go home on Thursday, but my surgeon didn't get in to see me in time -- he does outpatient surgeries on Thursdays. It didn't hurt me to remain overnight, but I was ready to go home sooner the second time. I can attribute it to different anesthesia and pain management approaches during the second surgery. I had general anesthesia and an ultrasound placed nerve block in my thigh for the second surgery and general anesthesia and a spinal block for the first one. I've heard good stories and bad stories from both methods. In my case, I had good results from both approaches.

That's something useful to remember, there seem to be as many different approaches as there are surgeons. If you're concerned about something, ask your surgeon why he or she does it that way. A lot of decisions are hospital protocol, and others are based upon the individual patient risk factors.

Good luck.


Jean

RTKR (Stryker Triathlon): 21 June 2016 LTKR (Stryker Triathlon): 21 April 2015
Right Knee Arthroscopy: 25 July 2006 Left Knee Arthroscopy: 10 February 2005
 

birdwatchr

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I was one who had out patient surgery. I was able to walk so many feet, use the bathroom, simple things like that before I was home 6 hours after surgery. I liked it that way as I felt more comfortable at home and did NOT want to be in a hospital for any reason! Didn't really have any problems at home either. Had more pain the next morning, but a call to the Dr helped with that.

PS I have never had a choice in anesthesia. Even though I want to stay awake, I've always been told NO, they will put me out totally, even for very minor surgery. The only one I was allowed to stay awake was my c section, and even then they threatened to put me out no questions asked if I felt any pain.
 
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lovetocookandsew

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Welcome!
I was offered the spinal option but there's no way I want to be anything but totally out during a major surgery. I even make them put me under for a colonoscopy! I also have Kaiser here in Northern Ca. and they generally keep people 2 days after a TKR, in my experience. But I am slow to recover and have problems often, so usually end up in the hospital 4 or 5 days after. When I had my latest surgery, the anesthesiologist came in right before the surgery and was talking to me about the spinal effects, etc. I asked him why he was asking me questions related to a spinal, and he told me he had just assumed I was having one. I told him to think again as I'd not only never consented to one, but was having a general. I also told him he shouldn't just assume as patients prefer different types of anesthesia and he should read their notes and also ask them. You can choose to have a spinal or GA-just tell your OS which you prefer, and make sure he notes it on the computer and in the paperwork you sign; also let the anesthesiologist know when you talk to him. (I've had Kaiser for over 40 years and am pretty knowledgeable about their system, etc.)

I'd also talk to your OS and make sure you feel comfortable with his time frames and your situation. My OS knows me well and knows it always takes me longer than 'normal' people to recover from the effects of surgery and I'm always in overnight for minor procedures that most people go home from the same day and several days for major procedures that are usually a day or two stays. He also knows I want out of there as soon as I'm able, but need to stay until I'm ready to go. I know many people just go along with what their doctor says is their usual procedure, but I always let them know I don't fit into that mold and will do what's best for me and my body. I've had at least 15 surgeries at Kaiser, and never follow the 'usual' course, but follow my own body's dictates. I've also found all my doctors tell me what the usual procedures are, but also acknowledge that everyone is different and some people will require a longer stay, etc. At which Kaiser facility are you having your surgery?
 
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Jean3600

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Hi Loves to Cook and Sew!

Thank you for sharing your information. It helps lots.

I am having surgery in Santa Rosa on Sept, 12th. I attended the Kaiser information class a couple of weeks ago but there were so many people in the class (50 plus) it was near impossible to ask individual questions.

I have only seen the operating orthopedist once, for about 20 minutes. He told me that he does surgery with the spinal block and that my stay would be overnight. I was so uninformed about the knee replacement surgery I didn't even know what questions I might have at that visit.

Now having read more about knee replacement, and having read comments here on Bonesmart, I have lots of questions. However I will have a phone call from a PA regarding meds, etc and then an in office visit with a PA and lab work a week before surgery.

I guess Kaiser does so many of these surgeries that it is an in and out kind of attitude. It's my first "real" surgery and I want to be more understanding of the processes involved and with recovery from it.
 

Lovestoread

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I had the epidural with "happy juice" that my surgeon preferred. Turned out to be great! I was not aware of the surgery at any time, nor dome remember anything. I recall being told they would be putting a tourniquet on my leg. The next thing I knew I was in recovery. My biggest fear was the epidural, which turned out to be no big deal. Because I didn't have general anesthesia, I didn't suffer from nausea as I had with previous surgeries. Also, I was able to go home a few hours after surgery (which I was thrilled with!) with no after-affects of general anesthesia.


Sent from my iPad using BoneSmart[emoji768]
 

lovetocookandsew

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Wow, you've only seen the OS once? I don't know how Santa Rosa works, but I saw my OS many times before the TKR. The doctor who did my TKR doesn't use his PAs as much as some others do, so with him I never saw a PA. I had changed to another OS for a while due to the overly busy schedule my original one had, but have since switched back as he does revisions and problems after a TKR which my other surgeon doesn't do. And I never see his PAs except in my room at the hospital after surgery on the days my OS didn't make it in. I saw his PA after my arthroscopy at two weeks, but then saw my OS at 6 weeks. This time, I have never seen any of his PAs except once in my hospital room; usually my OS comes in to check on me after surgery and I see him usually for all my follow-up appointments. My suggestion is to request an appointment with your OS before your surgery to ask questions galore. If they won't make an appointment with the OS, but make you go to the PA, then you may have the wrong OS and maybe the wrong Kaiser facility. I wasn't happy with the plastic surgeons at my local Kaiser a few years back, so switched to a different facility for that particular surgery only, and found one I really loved. Personally, I prefer seeing a doctor for major problems; PAs are fine for smaller things, IMHO. If I have a problem that's minor and temporary I'm fine with a nurse or PA, but for major and/or ongoing things, I want a doctor.

You can also change to a different OS if you decide you don't like the one you have, you know. It may delay your surgery a bit, but the surgeon is the single most important part of a TKR-I want the best I can find and one who cares about me as an individual, not as a 'knee'. And you can also let him know if you prefer a general, if you do, and you can tell him overnight isn't enough time as you will be home alone after, etc. It's your body, your knee, your life and your money that pays for the insurance-so you're the boss. Granted the OS has the knowledge, but he can't do anything without your permission, so let him know what you want.

I also went to the pre-op class-it had around 15 people, and we all asked lots of questions. I do disagree with the "window of opportunity" they push on patients, and if I ever took the class again and they were still spouting that line, I'd not only stand and dispute it, I'd give everyone the address of this website! I have noticed a lot of changes in the last couple of years, so I suspect the class has changed too. I'm not sure if this applies to your coverage, but Kaiser is now providing ice machines for knee surgery patients in the hospital and to take home and keep-that could be one of your questions. Good luck and let us know how it goes.
 

greatlakes

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Hi. I'm also overweight going into this. I suspect much more than you, as when I was with Kaiser for many years, they would not do the knee replacement unless I lost quite a bit of weight. The os who is doing my knee to,d me I would be in the hospital probably two nights. They have you in a special joint unit, and everybody is expected to attend morning and afternoon group pt, then get discharged at 3 the day of discharge. I have a friend who will drive with me to the city where I'm having this done (3 hour drive, after a 3 hour ferry trip) and we will stay in a hotel for a week, as the os wants to see his patients a week after discharge. I was going to stay by myself and have lots of small bills to tip the hotel employees to bring me ice and breakfasts, if necessary, but very gratefully accepted my friend's offer to stay with me that week. The dr could not promise a rehab recommendation until he saw how I was post op, so I sort of took the initiative to set this up instead.
The very best wishes to you!
 

KarriB

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TKR was my very first surgery or procedure also. I knew a little from my dad and friend having TKRs, but the hospital was a new experience for me. I'm sure you already have a list of questions for the dr or pa, be sure to ask how they will manage your pain as well as their philosophy on PT.

Will you be alone when you come home or will someone be with you? I think if you're home the same day you may need someone with you. I spent time in a transition unit which worked as a rehab but only had surgical patients. As Jamie said, some rehabs that also serve as nursing homes really don't know how to care for TKR patients.
 

newlybionic

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While the plan may be to send you home the day after surgery you would not be discharged unless you were able to meet the criteria set by your OS. Foremost being that you were medically stable. Then your ability to get to the bathroom safely, ability to get into your house and steps if needed and proper pain control. You need to discuss this information prior to surgery.
 

mamazipp

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@greatlakes you have even a longer trip to your OS and hospital than I did....3 hours drive plus only 1and 1/2 hour ferry ride. How wonderful to have a friend to offer to stay with you in the hotel and caretake you. That is a valuable friend for sure. If not for her, you would have to fend on your own and that would be difficult.
 

ACDCJen

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@Jean3600

I just wanted to say how sorry I am that your husband recently passed away. Mine passed last year and it has been so rough, especially since we knew that I would be having replacement surgeries in the future. I just thought we were going to be able to enjoy my newfound freedom together.

If you ever need a shoulder to cry on, please let me know. Hang in there...

Jen
 

greatlakes

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My sympathy to both of you. The world can be a pretty dismal place when you lose someone so close. A friend of mine said she is in the process of reinventing herself. I suppose this surgery is one type of reinvention, but so sorry your husbands are not here to see you through.
 

pdx

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Kaiser surgeons stay busy!
A couple of things: The pain-control and anesthesia protocols keep getting better, and Kaiser really insists that their surgeons keep up (or at least here in the NW.) I had mine a year apart, same surgeon, and the difference in each was astonishing.
As others have said, they won't discharge you until you can manage to walk a certain distance and safely get up to the bathroom. Do you have someone to come stay with you for a bit after discharge? Help with meals?
Make sure they know you live alone, etc. (I am also sorry to hear about your husband.) Kaiser up here almost never approves a rehab stay, but home health care should be available under your Medicare. Home health care can help with a shower, for example.
 

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I had my surgery on August 15th and went home August 16th. My surgeon does send many people home the same day. He probably kept me overnight because I'm older. He believes that patients are safer against infections at home and wants people home as soon as possible. I was physically able to go home the same day as I could get in and out of bed, go to the bathroom by myself, and take care of my personal needs.
 

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Hi Jean, I just spotted this thread Sept. 10, so your surgery may still be scheduled for 2 days from now. I am so sorry to hear of your husband's passing, as mine has been an absolute angel throughout my knee TKR. I'm not in the Kaiser system here in the Willamette Valley, so I can't speak to how they do things, but I was expected to be in hospital for 2 nights. This was my very first surgery or hospital stay, too. However, I had a blood clot ooze out through my incision the evening before I was to go home so they kept me another night. They also said no bending ROM work for a week, too. My concern for you, however, is that you are going home alone the day after surgery! My thoughts are: yikes! You will need a support person with you I would bet minimum of a week, or to be discharged to a rehab center. A friend of mine who had bilateral TKRs went to a rehab center that specializes in surgery recovery and rehab so she had 2 weeks of support there, then her son came to spend a week helping her, too. I really, really hope you have a support advocate who can help you get through this, as you might really need added help than you will have by yourself. I really hope you have been able to get more information and get better prepared, but keep us informed! This is an amazing and wonderful group of people who really do care about those of us who stop in to get advice! I hope to hear more about your surgery...
 

ACDCJen

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@Jean3600

I hope by now you are safely on the other side of surgery. I had mine on September 14 and spent 3 nights in hospital. I had be able to use a walker, get to the bathroom, and have a bowel movement, in addition to good pain control before going home. I was so glad to come home!!

Hope you are well!!

Jen
 
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