I had my ALIF 9L5-S1) at an outpatient surgery center in Dallas Tx on 12/12/11. everything went smooth on the day of surgery, with the total procedure taking under 1.5 hours.
I was discharged the next afternoon at about 5pm. My surgeon never saw me, nor looked at my dressings prior to discharge. The last time I saw him was about 30 minutes before induction.
Sent home with an Rx for 10/325 Norco, my instructions were to keep the bandage dry and see the doctor in his office on the 27th of December. The folks at the hospital provided my with aqua guard protectors to cover the dressing for showering.
I took a shower the next day and a small amount of water moistened the top layer of the dressing. I called the office and told the nurse that the bandage was slightly wet and that I was going to change it myself. (Formerly a paramedic, I have a understanding of wound dressings and sterile procedure)
The nurse proceeded to berate me for ignoring their specific instructions not to remove the dressing for two weeks. I told her that we were discussing history because I was not about to leave a wet dressing on a surgical site.
Two days later I was in severe pain at the incision site, called the doctors office, was berated again, and told to pick an emergency room, and have a nice day.
At the ER the incision was red, slightly discharging a pale pink yellow fluid. The ER doc ordered a CT to see if there were any other causes for my deep abdominal pain. The CT demonstrated cellulitis at the incision site and some air pockets in the small bowel consistent with ileus. The ER docs thought that an good dose of IV Clindamycin and some oral Keflex would probably handle the infection and recommended that I eat less.
Three days later I was in severe pain again and went back to that ER. The incision was definitely infected now, and the size of my extended symphony drum tight belly screened ileum. I was admitted, place on IV Vancomycin and IV Clindamycin.
Today I came home from that hospital and was sent directly to an infectious disease doctor who set up a PICC line and sent me home with $1,000 worth of IV Vanc. That's 7 days folks.
Here are my learnings from this disaster. Do a little better homework. 50% of all abdominal surgeries result in some degree of ileus. The reason you stay in the hospital 2 to 5 days is to insure that your bowels are functioning correctly, and that your incision site remains infection free.
Do not leave the hospital on the basis that a nurse claims to hear normal bowel sounds. Until you pass some flatus or fecal material your bowels are not working properly. Small bowel ileus can kill you, and ten though the small bowel sounds awake first, they don't stay awake if you pound them with 20mg of hydroxide every 4 hours. Oxycodone is much less likely to produce ileus, and should be the drug you're sent home with.
Dressings over surgical sites are going to seep fluid. Leaving a wet dressing on even 24 hours is never a safe idea. My slight exposure to water in a clean shower was not the source of this infection.
I now have open areas of an incision that must be packed with a saline cause by a home care nurse daily. The dressing that covers this wound is a special silver based foam that costs $13.80 for each 4X4 dressing , and I use two per day. By the way stuffing a salt filled dressing into an open incision is not even close to comfortable.
The IV antibiotics I'm taking are sometimes responsible for kidney failure and deafness. At a $1,000 a week they're also not designed for the uninsured.
So if you're Ortho wants you to do an easy 2 day ALIF.... don't walk....run out of his office and find a real doctor.
Yeah, I'm bitter.
L3-L4 Laminectomy micro-discectomy 2008
ALIF L5-S1 2012
Facet Joint Ablation L2 to S1 2012
Facet Joint Ablation. L2 to S1 2015