Recovery at Home

Definition
Purpose
Description
Preparation
Normal results

Definition

Recovery at home after surgery may require certain dietary and environmental restrictions, recommended rest and limitations to physical activities, and other required or restricted activities as recommended by a physician or surgeon.

Purpose

Postoperative recovery at home should promote physical healing and rest and recovery from the stress of surgery. For patients who undergo orthopedic surgery , the home recovery period will also involve rehabilitation to regain diminished musculoskeletal functioning. Emotional and psychological recovery from life-altering surgeries may also begin during the home recovery period.

Description

When patients are discharged from either an ambulatory surgical facility or a hospital, they will receive written instructions from their physician containing restrictions, requirements, and recommendations for their postoperative recovery at home. A nurse will usually review these instructions verbally with the patient and answer any questions and concerns. They may also call one or up to several days after a surgical discharge to follow up on how the patient is feeling and answer any questions about home recovery.

Restrictions and recommendations outlined in home recovery instructions may include:

• Driving restrictions. A patient may be prohibited from driving for a period of time due to functional limitations or to medication that impairs driving ability.
• Work restrictions. Depending on the nature of the patient’s job, he or she may be required to stay home from work or request alternate duties until recovery is complete.
• Social restrictions. Patients at high risk of complications from infection, such as an organ transplant patient, may be advised to avoid anyone with a cold or flu and to stay away from crowds or social gatherings during the initial recovery period.
• Medication recommendations. Prescription and/or over the counter drugs may be recommended on an as-needed basis for pain and nausea. Other drugs may also be required.
• Dietary limitations. Certain types of gastrointestinal procedures and other surgeries may require a restricted diet during the recovery period. Alcohol may also be prohibited, particularly if pain medication has been prescribed.
• Ambulation recommendations. The doctor will note if the patient should refrain from lifting heavy objects, climbing stairs, having sex, or participating in other potentially strenuous activities.
• Exercise recommendations. If movement, stretches, or exercise is encouraged as part of recovery, that fact will also be noted.
• Incision care. Patients are instructed on how to care for their incision and educated on signs of infection (i.e., redness, warmth, swelling, fever, odor).
• Home care needs. Some patients may require a visiting nurse or live-in health aide for a period of time as they recover from surgery.
• Adaptive equipment. Assistive or adaptive devices such as crutches, a walker, prosthetics, or bed or bathroom hand rails may be necessary.
• Follow-up with physician. A patient may be instructed to call the doctor’s office to schedule a follow-up appointment. The patient should also be given criteria for warning signs and symptoms that may occur with the procedure, and when to call the physician if the symptoms appear.
• Other required medical appointments. If a patient has undergone orthopedic surgery or another procedure that requires rehabilitation, he or she may need

KEY TERMS

Ambulation— To walk or move from place to place.

Ambulatory care— An outpatient facility; designed for patients who do not require inpatient hospital treatment or care.

Prosthetics— A custom-built artificial limb or other body part.

Orthopedic— Related to the musculoskeletal system, including the bones, joints, muscles, ligaments, and tendons.

to see a physical or occupational therapist to regain range of motion, strength, and mobility. Depending on the type of surgery performed, the expertise of other medical professionals may also be required.

The postoperative period is also a time of emotional healing. Patients who face a long recovery and rehabilitation may feel depressed or anxious about their situation. Providing a patient with realistic goals and expectations for recovery both before and after the surgery can help avoid feelings of failure or let down when things do not progress as quickly as the patient had hoped. Realistic recovery expectations can also prevent a patient from doing too much too early and potentially hindering the healing process.

Certain life-altering surgeries, such as an amputation or a mastectomy, carry their own set of emotional issues. Counseling, therapy, or participation in a patient support group may be an important part of postoperative recovery as a patient adjusts to the new post-surgical life.

Preparation

Discharge recommendations for home recovery are typically explained to the patient before he or she is allowed to leave the hospital or ambulatory care facility. In some cases, the patient may be required to sign paperwork indicating that he or she has both received and understood home care instructions.

Depending on the surgical procedure undergone, a patient may be taught some home care techniques while still in the hospital. Physical therapy exercises, incision care, and use of assistive devices such as crutches or splints are a few self-care skills that may be demonstrated and practiced in an inpatient environment.

A physical and emotional support system is a crucial part of a successful home recovery. Faced with restrictions to movement, driving, and possibly more, a patient needs someone at home to help with the daily tasks of independent living. If family or friends are not nearby or available, a visiting nurse or home healthcare aide should be hired before the patient is discharged to home recovery.

Normal results

Following home care instructions can help to speed a patient’s recovery time and ensure the safe resumption of normal activities. In some cases, the familiar, comforting home environment may even speed the healing process or improve the degree of recovery. One study of patients 64 and older undergoing hip surgery found that patients who were allowed to undergo rehabilitation at home had significantly better outcomes than those who underwent rehabilitation as hospital inpatients. On average, the former had better physical capacity and independent living skills when assessed six months after surgery.

Some studies have also indicated that gender may have an impact on the success and speed of postoperative home recovery. Some studies have found that women recover more rapidly than men. However, animal and laboratory studies have found that progesterone and estrogen may be involved in the period immediately after surgery or injury. This would indicate that women may have a natural advantage in recovery. Scientists continue to study the recovery process to try to understand it and help patient recovery as quickly and completely as possible.

Resources

BOOKS

Brunicardi, F. Charles et al, eds. Schwartz’s Principles of Surgery, 8th Ed. New York: McGraw-Hill, Health Pub. Division, 2005.

Hatfield, Anthea and Michael Tronson. The Complete Recovery Room Book, 3rd Ed. New York: Oxford University Press, 2002.

PERIODICALS

“Gym Workouts Ease Heart Patients Back Into Normal Life.” Nursing Standards 21.30 (April 4, 2007): 10–11.

“Many Think the Worst Part of Recovering from Surgery is Getting Over the General Anaesthetic.” British Medical Journal 328.7443 (April 3, 2004): 844–845.

Doering, Lynn V., Anthony W. McGuire and Darlene Rourke. “Recovering from Cardiac Surgery: What Patients Want You to Know.” American Journal of Critical Care 11.4 (July 2002): 333–344.

ORGANIZATIONS

National Association for Home Care and Hospice. 228 Seventh Street SE, Washington, DC 20003. (202) 547-7424. http://www.nahc.org.

Visiting Nurses Association of America. 99 Summer Street, Suite 1700, Boston, Massachusetts 02110. (617) 737-3200. http://www.vnaa.org.

Paula Ford-Martin

Robert Bockstiegel