Surgery

Preparing for Surgery

The Orthopaedic Surgeon has evaluated your child and determined that there is a need for surgery.

We understand that this time is stressful for your entire family, so we have prepared this booklet to help guide you through the experience.

Although we plan many surgeries every year and are familiar with giving guidance in regards to preparations for surgery, each child and family is different. Please feel free to ask questions at any visit or call the orthopedic department.

Please take the time to read through this booklet, take some notes, and prepare. We have found that a little preparation will save a great deal of worry, and help everyone who cares for your child have an easier time. Thinking about home care needs before surgery is important. Working together with the orthopedic staff you can make the transition from planning to surgery to home a much less stressful experience. 
 

Scheduling Surgery

For elective surgeries your surgeon will complete a planning sheet after your visit and give it to the office assistant. She will call the parent or guardian to schedule surgery and pre-operative visits. Please be sure we have your correct home information. Insurance authorization is requested about 4 to 8 weeks before surgery.

If your surgeon decides that surgery is urgent (within a week or two) or an emergency (within a day or two), he or she will notify the office assistant. You will be called as soon as possible with the date and time. The office staff will obtain authorization. Urgency is determined by medical necessity, not by social reasons. Neither the office staff nor a family member can determine urgency of a surgery, only the surgeon can do that.

After scheduling the surgery date we will arrange a pre-operative history and physical by the surgeon and an evaluation by the anesthesia service. Any pre-operative tests, such as MRI or CT scans will also be scheduled. These appointments are usually a few days to a few weeks before surgery.

Contact the office for questions regarding scheduling.
 

Pre-Operative Visits

Pre-operative visits and phone call are necessary to be sure your child is healthy for surgery, and to thoroughly explain the operation. We also want you to understand the risks and benefits of performing surgery.

Everyone (parents, grandparents, guardians, etc) who wishes to discuss surgery should come to the pre-operative visit. The surgeons allow time during this visit to describe the surgery and answer all of your questions. Their busy schedules do not allow time to call and discuss the information again with those who were unable to come.

Please bring the child’s insurance card to all visits. If you are not the child’s biological parent please bring proof of legal guardianship, or the court papers necessary to obtain consent. 

Anesthesia Pre-op Visit

Many children will need an evaluation by the anesthesiology service before surgery. This appointment is with a Nurse Practitioner from the Anesthesia service. At this appointment you will hear about anesthesia, how to prepare for surgery, and information about post-operative pain control. If your child takes medicine be sure to ask at this appointment about how to give it on the day of surgery.

Blood tests may be done during the visit or on the day of surgery. All girls over 12 years old must have a urine pregnancy test on the day of surgery before anesthesia. Call 510-428-3665 for questions on Pre-op.

During this visit younger children may have some time to prepare for surgery with our Child Life staff. The pre-surgical preparation program is age specific and helps deal with the fears most children have of the unknown. The visit is play oriented with hands-on time to see how our equipment “really works” and picture books to look at. For more information on preparing your child, contact our Family Education and Resource Center at 510-428-3549.

The Night Before Surgery

To avoid complications during surgery, the child must have an empty stomach on arrival to the hospital. Please follow your instructions about when to stop milk, formula, foods and clear liquids. It takes at least 8 hours to empty the stomach. If the child eats or drinks anything, surgery may have to be cancelled.

If your child takes medication, follow directions given at the pre-operative anesthesia appointment for whether or not to give it the night before or the day of surgery. If you will not been seen by anesthesia, ask one of the orthopedic nurses or doctors for instructions.

If desired, your child may bring a favorite toy, blanket or doll for comfort. Older children may even choose to bring a favorite object. The night before is a good time to decide on what to bring.

The night before surgery is also a good time to be sure all braids and beads are removed from the hair and all jewelry (including all body piercing rings) and nail polish are removed. Contact lenses are not allowed, please plan on wearing glasses to the hospital. If you have questions about what is allowed, please ask at a pre-operative visit.

What to pack:
PJs, socks and underpants, slippers, a hair brush, toothbrush and paste and Chapstick. You will also need a set of clothes to wear home. Bring a list of all medications the child takes and your insurance information.
Do Not bring valuables.

Finally, try to get a good night’s sleep. It is very tiring to prepare for surgery, and waiting for the child to come out from surgery will be much easier if you are rested. The child will feel much more able to cope with the stress of surgery if rested too. 
 

Home Care Needs/Equipment

Many children will require some special equipment for use at home after surgery. The nurses will begin planning for your surgery after the operative planning sheet is finished, and a surgery date is set. The equipment is generally ordered one to two weeks before the surgery date for elective surgery, and as soon as possible for urgent/emergent surgeries.

We will determine usual post-operative needs (ie: wheelchairs, braces, dressing supplies, ice machine) and request authorization from your insurance. If your insurance authorizes the equipment, it will be ordered for delivery either to your home or to the hospital. We must have a street address to order any durable medical equipment.

If you have special needs, or requests, please contact the nurse about 2 weeks before surgery. If your insurance does not cover the equipment, in part or in whole, you may discuss options or pay for it yourself. The supplier generally collects co-payments on delivery.
If equipment arrives, and you are unsure if it is needed, please call the nurse before refusing delivery. Re-ordering can be difficult and may delay the equipment delivery.

If you recieve any equipment for mobility, comfort or bracing before surgery (ie: knee brace, ice machine, crutches, a walker or wheelchair or personal supplies), bring it with you the day of surgery. Home care equipment (ie: commode) may be left at home.

Home Nursing Care

Home nursing is almost never covered after surgery. Please arrange for care after discharge as your child will likely need to stay home for several days to several weeks, depending on the surgery.

Transportation

Transportation to and from the hospital and for required follow-up appointments is also almost never covered by insurance. You will need to pre-arrange secure transportation for discharge, and for post-operative check-up visits.

Contact the office for questions regarding home care needs or equipment.

Hip Spica Casts and car seats:
In California, all children under 6 years old, and/or under 60 pounds are legally required to be in an approved car seat at any time the vehicle is in motion. Car seats are not required on public transportation. If your child will be in a spica cast after surgery, they may not fit into a regular car seat. Very few insurance companies will pay for a spica car seat (Spelcast CRD). The seats cost about $300, and take 2 weeks to order. We have a very limited supply of these seats for loan. We are dependant on their timely return to be available for loan to the next patient, so there is no way to predict if one will be available for your child. We have a vest restraint system that may also be available. Please talk to the nurse to discuss the options regarding transporting a child in a spica cast. 
 

Hospital Stay

Before surgery you will discuss the expected length of hospital stay, if any, after surgery. Sometimes children need to stay unexpectedly, but this is unusual. One parent may stay at the bedside, there is a window seat or a pull out bed in all units except ICU. It is of great comfort to your child to have a familiar caregiver here at all times, and this is strongly encouraged.

We determine the readiness for discharge based on several things. The child must be able to eat a normal diet, although not necessarily normal volume of food, and must be drinking enough liquids. The child must also be comfortable on pain medicine by mouth. There may be additional, specific criteria for discharge for individual patients.

Discharge Time
Children’s Hospital has a discharge time for in-patients of 9 to 11 am. Please plan ahead to have a ride ready by that time, and belongings packed up. Special arrangements must be made ahead if the normal time cannot be kept. 
 

Home Care and Follow Up

Pain Control
Follow the instructions printed on the bottle for the pain medicine. It is usually best to give the prescription pain medicine regularly for a day or two, and then try plain Tylenol (acetaminophen) or Motrin (ibuprofen) as the pain gets better. (No ibuprofen with any bone graft/fusion) Call the nurse if it is not helping, or is making the child nauseated.

Pain medicine will almost always cause constipation. Immobility also causes constipation. Increasing juice (all but Orange) will help soften stools, and increasing fiber will help with regularity.

Elevating the area and applying ice (to the dressing or the cast) can also ease pain.

Cast Care
You must keep the cast dry at all times. For bathing you must avoid splashes on the cast. Wrap the cast in 2-3 plastic bags or a cover device (purchase at local drug store) sealed tightly, and then hold the cast either over the edge of the tub or outside of the shower. You may not dunk the cast in water, or keep it in the shower, even if wrapped. The cotton padding is very hard to dry, and can cause serious skin and incision problems if it becomes wet.

Don’t scratch under the cast with anything. If itching is severe, try a blow drier on cool setting or lightly scratching the other arm/leg. Never put anything into the cast to scratch.

What to watch for?

Casts:
Check the fingers/toes of the casted extremity every 4-6 hours for the first few days.
Call the orthopedic nurse, or the on-call resident (at night or on weekends) right away to report any of the following :
1. Numbness or tingling (fingers/toes)
2. Swollen, blue, cold (fingers/toes)
3. Extreme pain, throbbing in cast

General :
1. Redness at pins or incision.
2. Drainage from pins or incision.
3. Fever over 102 (low fever is common)
4. Uncontrolled pain
 

Cast Removal

Casts are removed with a vibrating “saw”. The cast saw does not cut skin, and it is cushioned by the cotton padding. Unfortunately, it is very loud and vibrates. Talking about how it may sound and feel in a positive way will help your child cope during the procedure. It only takes a minute to cut the sides of the cast, but for a frightened child it can seem like a lifetime of crying. It may help to make it sound like a “thrill”, (“it will make you giggle!!) and not like something scary. Don’t prepare too far in advance, but the morning before you come would be enough for most children.

Pin removal
Pins may be removed in clinic. The process is not particularly painful, but tends to cause much anxiety. Pins are actually smooth wires, bent over at the outside end. There is usually a dressing and cast over the pins. After the cast is removed, the pins pull out smoothly causing an “odd” sensation, bleeding, and sometimes brief, mild pain or stinging. The child may bathe after 12 hours if the arm/leg is not re-casted. 
 

Post-op appointments

You will need to make an appointment for a post-operative check. We prefer to make this appointment with you while you are here for your pre-operative visits. If not, please call as soon as you can, as you will need to be seen one or two weeks after surgery to check the incisions, and remove dressings so the child can shower. Return visits thereafter can be made at the end of each appointment, at the Orthpaedic desk. 
 

Physical Therapy

Sometimes Physical Therapy is ordered to begin after surgery. We make every effort to have these orders done at the pre-operative visits, so that authorization can be obtained and the first visit scheduled as soon as possible. Depending on your insurance, we will process the authorization request and provide you with a list of providers to choose from. Please contact our Physical Therapist for any questions regarding your PT plan. 
 

Important Phone Numbers

Orthpaedic Department main #
510-428-3238

Children’s Hospital main #
510-428-3000

Appointment Scheduling

Oakland: 510-428-3238 or
Larkspur: 866-854-0550
Walnut Creek: 925-939-8687