Patients

If you have undergone, or are going to undergo surgery, please read our recommendations carefully.

Remember that, if you go to Quironsalud Hospital Badalona, we carry out consultations, operating theatres and hospitalisation there.

At our centre in Aribau street, we carry out outpatient consultations and rehabilitation, while surgery, hospital stays and emergency care are carried out at the Hospital El Pilar in Balmes street, also part of the Quironsalud Group.

Consultations and Rehabilitation:

Quirónsalud Aribau Medical Centre
c/ Aribau, 192-198. 2nd floor
08036 Barcelona

Surgeries and Hospitalisation:


El Pilar Hospital
c/ Balmes, 271. 08006 Barcelona
Surgical area (2nd floor)

Consultations, Surgeries and Hospitalisation:

Quirónsalud Badalona Hospital
Carrer de la Seu d’Urgell, 77
08911 Badalona, Barcelona

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Recommendations for the patient and relatives

Recommendations before an intervention

If you are going to undergo surgery in the coming days or weeks, please consider the following recommendations:

Background

  • If you have any medical condition such as diabetes, hypertension, heart disease, or others, make a prior visit to your specialist in order to have this condition under control. In any case, prior to the operation you will undergo a preoperative study and sometimes a pre-anaesthesia consultation will be carried out by an anaesthetist.
  • Refrain from smoking in the weeks before and after surgery as the poor tissue oxygenation caused by smoking has been shown to adversely affect the healing capacity of tissues; heavy consumption of alcohol or other stimulant substances is also discouraged.

Medicines

  • Continue with your usual medication until the day of surgery with the exception of antiplatelet medication which should be stopped 1 week before surgery. (Aspirin – Adiro®, Clopidogrel – Plavix®).
  • If you are taking Sintrom®, see your GP to switch to anticoagulant treatment with heparin 1 week before surgery. Do not administer heparin in the 12 hours prior to surgery.

Preparation

  • On the day of the procedure, carefully wash the area to be treated and do not apply any deodorant, lotion or make-up to the body.
  • With the exception of shaving the face in men, you must not shave any area of the body in the days prior to the operation, especially the area to be treated, as this may increase the risk of local infection. If necessary, the preoperative shaving of the area will be carried out in the ante-operative area by medical personnel.
  • Maintain at least 6-8 hours of fasting prior to surgery (including solids and fluids); increase fluid intake the day before to avoid dehydration, although this should not be a concern as fluids will be administered during the procedure.
  • Be accompanied by an adult who will be responsible for accompanying you to your home or alternative accommodation at the time of discharge.

Fever

  • If you think you may be suffering from an active infection of any kind on the day of surgery, let your surgeon and anaesthetist know so that they can assess the risk of the spread of such an infection; in some cases, it is advisable to postpone the date of surgery for this reason. A simple cold, however, is generally not a reason for postponement.
  • If you have a fever or other symptoms of discomfort, are pregnant, or other circumstances that may contraindicate the procedure, also discuss this with your surgeon and/or the anaesthesiologist.
  • Also report any wounds or rashes in the area to be operated on.

Miscellaneous

  • Whether or not you are going to remain in hospital, it is necessary for a family member or friend to accompany you to facilitate your transfer home at the time of discharge.
  • Remember that hospitals do not provide crutches on discharge so get a set if you have had lower limb surgery and take it with you to the hospital.
  • If you know or expect to be admitted, bring comfortable, loose-fitting clothes that can be worn over a bandage or splint on discharge; also bring toiletries; the rooms can comfortably accommodate a companion for the night.

Papers to take with you at the time of admission

  • Complete pre-operative: CBC with coagulation, Electrocardiogram and Chest X-ray.
  • Signed consent to surgery, authorisation from your insurance company if applicable.

Recommendations after an intervention

Hospital discharge

  • On discharge, the patient will be given a report including all the details about the type of intervention he/she has undergone, the intraoperative findings, the medication to be taken and a series of recommendations; he/she will also be given information about the next appointments, usually a week after the intervention to evaluate the wound and a month after the consultation, sometimes accompanied by a radiological study.
  • Depending on the process, it is likely that you will be scheduled for an appointment with the Rehabilitation Service during the first postoperative weeks, usually 2-3 weeks postoperatively.

Wound

  • Keep the wound clean and dry; if wearing a soft bandage or dressing change it every 24-48 h, carefully remove the removable knee brace or sling first and then replace it; clean the wound with chlorhexidine, alcohol or betadine with sterile gauze and keep the area covered with dressings until complete closure; arthroscopy wounds can usually be wet after 7 days and incisions longer than 5 cm are safe after 2 weeks. If you are wearing a splint on your leg, do not remove it yourself, wait until the next medical visit.
  • You may experience swelling and discomfort especially the first 2-3 weeks postoperatively; if the bandage is not too thick, apply local cold for 20 minutes every 4 hours, remember never to apply cold directly to the skin and if you use an automatic cold application device, strictly follow the manufacturer’s recommendations, incorrect application of local cold can cause severe skin burns.

Medication

  • Take the painkillers recommended by your Surgeon as reflected in the discharge report. If your surgery is ambulatory, plan to have analgesic medication at home for the first few days; the most common analgesics on discharge are Metamizol alternating with Paracetamol and Tramadol in cases of poor pain control. Ask your doctor for other analgesic options in case of allergy to any of them:
    • Metamizol (Ej.: Nolotil®) 1 comp/6-8 h. or 1 amp/6-8 h. for greater effect
    • Paracetamol (Ej.: Efferalgan®) 1gr/8 h. (Not to exceed 4 g/day in adults)
    • Tramadol 50 mg 1 comp/12 h.; if nauseous take Metoclopramide 10 mg/12 h. (Ej.: Primperan®).
  • Si ha sido dado de alta el mismo día, recuerde que la primera noche tras la intervención es la que puede haber más dolor, por lo que prepare la medicación con antelación, mantenga la extremidad elevada y guarde reposo, aunque se encuentre bien.

Fever

  • An infection after surgery, although very infrequent, can occur and usually starts after 5-7 days, generally with a fever of +38ºC, increased pain, redness and general malaise; in this case, go to the Emergency Department of the Hospital where you have undergone surgery for evaluation or, if it is a working day, ask if you can visit your doctor on the same day.
  • Sometimes a haematoma causes a rise in temperature and discomfort when standing up or moving; the temperature in these cases will generally be below 38 ºC, so if you feel reasonably well and with no increase in pain compared to the previous days, do not worry and simply rest a little more and elevate the limb.
  • For rapid resorption of haematomas, Thrombocid ointment can be applied; do not apply directly to wounds if they are not completely closed. Apply local cold and rest.

Recommendations to family members during an intervention

Operating theatre times are always approximate and there may be variations in the order of patients during the day due to a multitude of factors that do not affect your relative’s surgery so please wait with the patient until they are advised to go to the operating theatre; if there are any major variations they will be advised by the doctor or administrative staff.

The time from the moment the patient leaves the room to go to the operating theatre until he/she returns to the room also varies greatly and doubles or triples with respect to the time of the surgery itself due to the multitude of processes to be carried out before and after the operation; please do not worry if you see that a lot of time has passed, the surgeon or an assistant will inform you at the end of the operation as soon as possible or will come by the room at the end of the surgical day, remain calm, you will be informed of how the operation has gone and the steps to follow from that moment onwards.

Outpatient surgery

Selection

  • Outpatient surgery is surgery in which the patient is discharged home on the same day as the operation.
  • It is an efficient practice that generates high patient satisfaction.
  • El Pilar Hospital has a specific area and an optimised circuit to carry out outpatient interventions.
  • Ask your surgeon if you are a good candidate for outpatient surgery; it is regularly applied in surgeries of medium complexity, lasting less than 2 hours, and in patients without serious illness or advanced age.
  • Most arthroscopic techniques are suitable for outpatient surgery (meniscus surgery, knee ligament reconstruction, rotator cuff repair, shoulder dislocation surgery).

If you are considered eligible for Outpatient Surgery please note the following:

Medical discharge

  • Arrange for a responsible person to accompany you home; note that public transport is not recommended and that you are not allowed to drive.
  • There is a possibility that the doctor may decide to extend your hospital stay until the next day.
  • You will receive a medical report upon discharge indicating the need for a medical check-up in about a week’s time.
  • This report contains detailed information on the analgesic treatment to be followed for the first few days after the operation.
  • Rest at home for the first week and follow your surgeon’s recommendations.
  • In the event of any anomaly or pain that is difficult to control, the 24-hour Emergency Department of the Hospital El Pilar is at your disposal.
  • In case of an emergency, go to any hospital.

Recommendations on rehabilitation

Rehabilitation and physiotherapy is an important part of the treatment of a multitude of trauma conditions and even more so following surgery.

Follow your specialist’s recommendations for mobility and strength exercises to be performed at home.

Shoulder

  • After shoulder surgery in most cases from the first day, elbow extension and bending is allowed with partial removal of the sling; gravitational and swinging exercises can be performed after the first week; use the sling if instructed to do so during the day when moving and at night when sleeping to avoid involuntary jerking movements, especially during the first 4-6 weeks or until instructed to remove the sling.

Knee

  • To rehabilitate a knee during the first days or weeks after an operation, it is recommended to perform isometric exercises of straight leg elevation, a correct guideline is for example to perform 4 series of 15 repetitions every 2-3 hours. After the first week, you can remove the knee brace if you are wearing it and perform gentle flexion-extension movements with the help of the other leg for 5-10 minutes each day, reaching up to 80-90º of flexion; then put the brace back on, this helps to avoid developing stiffness; if you are not wearing a knee brace or splint, it is because there are no restrictions on knee flexion.
  • Ask when you can support your leg, this information will generally be in the discharge report or will have been communicated by your surgeon in advance; in any case, when you start walking, do so with the help of two crutches and in a progressive manner. If you are not allowed to support your leg, use the crutches, but do not put weight on the operated limb.
  • Once the load has been authorised, the way of starting to walk with crutches must be progressive, supporting little weight at first, 10-20%, and increasing this percentage every week. The two crutches go forward at the same time as the operated or injured leg, except that the support is greater on the forearms.
  • When you are able to walk easily with two crutches, switch to one crutch, release the one on the arm corresponding to the operated side and keep the other; likewise when walking, you walk with the operated leg and the crutch at the same time, concentrating on making a short but correct step, extending and bending the knee as naturally as possible.
  • It is very important that the extension of the knee is equal to that of the other, non-operated knee; whether or not you are wearing a knee brace, perform extended knee downward pressure exercises while lying down for a count of 5 seconds. Do not rest or sleep with a cushion under your knee under any circumstances. You can place the cushion under the heel and this will make it easier to extend the knee, you will feel tension in the popliteal fossa for a while, but this discomfort will subside as the days go by.

Hip

  • For hip rehabilitation in the first postoperative weeks, it is important to perform isometric gluteal and quadriceps exercises, as well as straight raises of the operated leg without additional weight. A good guideline would be to perform 4 sets of 10-15 repetitions, with 2-3 hours rest between sets. From the second or third week onwards, if not otherwise instructed, controlled hip abduction and flexion movements in a limited range, between 20° and 45°, can be initiated with the help of the other leg or a professional.
  • Full weight bearing on the operated leg will depend on the surgeon’s specific indications, but it is recommended to start with the use of two crutches to reduce the direct load. When partial weight bearing is authorised, start with 10-20% weight bearing and gradually increase, maintaining gait stability. As recovery progresses, you can switch to a single crutch on the side opposite the operated leg, advancing both crutches at the same time and taking controlled steps.
  • It is crucial not to cross the legs when sitting and to avoid flexing the hip more than 90° during the first weeks to prevent dislocations. Always maintain good pelvic alignment to promote symmetry of gait.

Foot and Ankle

  • Rehabilitation of the foot and ankle can be started with early mobilisation exercises as soon as movement is allowed. In the first few weeks, perform ankle flexion and extension exercises (toe-off and dorsiflexion movements) and gentle circles to regain mobility. These exercises can be done 4-5 times a day for 5-10 minutes.
  • If you are allowed to support your foot, do so progressively with the help of crutches, increasing the weight by 10-15% per week until full support is achieved.
  • Once authorised, it is also beneficial to perform strengthening exercises, such as seated heel raises (with the knee bent at 90°) and then standing when the load is tolerated, always supported by a stable surface.
  • To improve proprioception and balance, start with exercises on stable surfaces before moving to unstable surfaces. Wear appropriate footwear that offers good support and avoid hard impacts until full mobility and stability are achieved.

Hand/Wrist

  • In hand and wrist rehabilitation, it is common to start mobility exercises as soon as they are authorised, performing flexion, extension, radial and ulnar deviation movements. Start with sets of 10 repetitions every 2-3 hours, maintaining a controlled speed to avoid discomfort. A splint may be needed to protect the joint for the first few weeks; consult the appropriate time to remove it depending on your case.
  • As recovery progresses, add strengthening exercises with a rubber ball or elastic band. Perform hand opening and closing movements and finger extensions against resistance 3 times a day in sets of 10-12 repetitions. Avoid heavy lifting or twisting movements until you have adequate mobility and strength.
  • An important element is to keep the wrist in a neutral position when resting, avoiding hyperextensions.

Elbow

  • For elbow rehabilitation, in most cases, it is allowed to start controlled extension and flexion exercises from the first day after the operation. Perform gentle flexion-extension movements in sets of 15 repetitions every 3-4 hours.
  • If you have a splint or immobiliser, check with your practitioner when it can be removed to perform these exercises. As you gain mobility, you can add forearm rotation exercises (supination and pronation) and perform isometric exercises for the biceps and triceps without additional resistance.
  • Once you have clearance, you can begin strengthening exercises with elastic bands, performing 2-3 sets of 10-12 repetitions of flexion and extension. Avoid excessive weight bearing and twisting movements in the early phases, concentrating on regaining a full and controlled range of motion.