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Prior to your admission you will have made arrangements at Macquarie Neurosurgery office or received a phone call from the Admissions Office at Macquarie University Hospital confirming your date for admission and the time for arrival at Macquarie University Hospital. At the time of this call you will also be informed of any payments due for your hospital stay as determined by the Health Fund (i.e. any excess due under the terms of your cover).
In preparation for your hospital stay it is advisable to pack a small bag with your personal effects such as toiletries and sleepwear. It is essential to bring with you any XRays or scans you have, your medications, medicare care card and health fund card.
Arrival at Hospital:
On arrival at the hospital go to Reception in the Lobby where the admission procedures will commence.
Admission to the Ward:
The Macquarie University Hospital resident doctor will do a complete medical admission including your medical history, current symptoms and any current medication you are taking. The doctor will also do a physical examination and arrange for any further tests that are required.
You will have to fast ("nil by mouth") from midnight before
surgery. If your surgery is to start later in the afternoon, fasting
may commence early in the morning.
A member of the surgical team will visit you before the surgery at which time you will be given the opportunity to ask further questions and/or have the procedure explained in detail.
Your family is more than welcome to stay with you during the course of these events. A member of the surgical team will visit any relatives in the ICU waiting room either at the end of surgery or at the end of the day.
Day of Surgery:
On the morning of the surgery you will not be permitted any food or drink apart from a sip of water with your morning medications. The nursing staff in the ward will ask a series of questions related to a routine checklist on departing the ward. Before leaving the ward the nursing staff may give you medication which will sedate you and make you sleepy but is not part of the full anaesthetic. Your family may visit prior to your leaving the ward but will be encouraged to leave the hospital while you are in the operating room. Their contact details will be obtained so they can be notified of the time to return to the hospital in time to meet with the surgeon at the end of the procedure.
On arrival in the operating room area you will be met by the anaesthetic nurse who will again ask a series of questions related to the operation. You will be instructed by the nursing staff as to what will take place during the anaesthetic. The anaesthetist will proceed to insert a needle into a vein to commence an intravenous infusion and the drugs to put you off to sleep. Also at this time a urinary catheter may be inserted into the bladder to collect urine, which will remain in place post-operatively until such time as it is deemed no longer necessary.
Once all the monitoring has been connected and anaesthetist has completed the commencement of anaesthetic, the surgical team will then prepare the operation site for surgery. This will include shaving of the operative site, preparation of the scalp and draping of the operative site.
The surgery will then be performed by the surgeon with assistance of members of the surgical team.
Following the Operation:
On completion of the operation by the surgical team, the anaesthetic team will end the anaesthetic and wake you up again. Once you are stabilised you will be transferred to the Intensive Care Unit (ICU) for your post-operative care. On arrival in ICU the medical and nursing staff will connect you to various monitoring machines, check your observations, infuse appropriate medications, and ensure your reasonable comfort before allowing your immediate family to visit you. After most surgery will be awake but very drowsy and although you might be able to answer their questions etc you will have no memory of their presence at this stage. For certain surgery there is a medical necessity to leave you sedated, intubated and ventilated. This will usually be anticipated prior to surgery but is occasionally made necessary during the course of the surgery (example being for strict blood pressure control). If this is necessary, you will not be aware of the intubation and be kept comfortably asleep. The surgical team will also meet with your relatives at this time to inform them of how the surgery went, the findings, and their expectations during the early post-operative period.
Your length of stay in ICU will be dependent on the complexity of the surgery, your rate of recovery and your requirement for monitoring and medications. On the morning following the surgery you will usually undergo a CT scan to check for any complications at the surgery site e.g. swelling of the brain and collection of fluid. This is a routine procedure for all post-operative brain surgery cases and is not something to be alarmed by. Depending on the surgery you have had, it may be necessary for you to undergo a repeat cerebral angiogram to check completeness of the surgery and again to eliminate any post-operative complications with the blood vessels.
When the surgical team and ICU team are happy with your progress in the recovery phase, you will be discharged from ICU and transferred to the ward where you will stay until such time you are ready for discharge either to a rehabilitation unit or home (again, depending on the type and complexity of the surgery performed). During the entire post-operative period, both in the ICU and the ward and up until the day of discharge, you will be visited by a member of the surgical team on a daily basis (not always on Sunday). The timing of this daily visit is not set as the surgeons can be held up in consulting rooms, operating rooms, education etc. However, a member of the team will visit.
During your entire post-operative phase whilst in hospital you will be visited by the physiotherapists who will assist you with deep breathing and mobilisation following the surgery. You will be surprised how quickly you are encouraged to get out of bed to sit in a chair (this will commence whilst in ICU) and gradually walk further distances as you build up your strength. When you are managing well and feeling stronger you will be discharged from hospital usually 7-14 days following surgery. Before discharge you must be comfortable, be afebrile, have opened your bowels, and have a normal white cell count. This varies from individual to individual. For some cases where a prolonged stay is required in ICU to manage vasospasm 21 days is the usual length of stay. Your sutures will be removed at day 14 but you will not be able to wash your hair for a further 14 days after the sutures have been removed.
What to expect once you have left hospital:
When you first leave hospital you can expect to feel not quite as strong and confident as you did in hospital. This is a normal feeling and is usually due to the fact that you are no longer surrounded by all the medical support. This does not mean to say that you will necessarily be unable to manage as well but is essentially a related to your confidence and will soon pass – usually once you get back into your normal sleeping pattern.
During the six week period between leaving hospital and your post-operative visit to the surgeon in the consulting rooms you will experience some different symptoms which might worry you at the time but are all part of the normal healing process. These include:
• Pain over the operation site – this can develop any time from 2 weeks from surgery to three months and is the ‘waking up’ and repair of the nerve endings in the scalp which have been cut at the time of surgery.
• Swollen closed eye – again this is as a result of the opening of the skull and gaining access to the brain which takes place very near to the eye socket. The swelling will go down and the eye will open shortly following the surgery. When the eye first opens you may experience some double vision but again this will be expected to resolve.
• Low back pain and pain in legs – this is called ‘arachnoiditis’ and is a result of blood (albeit small amounts) travelling through the CSF (fluid around the brain and spine tissue) to the base of the spinal column. This leads to irritation of the nerves to the buttock and legs. This will resolve with time.
• Fatigue – this is a multifactorial result of the magnitude of surgery that you have undergone. It is your body telling you that you are doing too much and that rest is an important part of the recovery period. To build up your strength you should increase your activity daily but stop for short periods when you feel tired.
Post op consultation:
You will be asked to make an appointment with the surgeon for six weeks following the date of discharge from hospital. Often this appointment will be made for you by the ward staff (but not if you are discharged on the weekend). If you do not have this appointment before you leave hospital you should ring the rooms (+61 2 9812 3900) to make this appointment. This visit to the surgeon is very important as he/she needs to check the surgical wound/s, your physical state and neurocognitive state as part of the full assessment. Depending on the results of this visit you will be instructed as to when you next follow-up appointment should be and is made by the secretarial staff before your departure from that appointment. There is no fee for this appointment as it is covered by the surgery fees.
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