"What Happens on Surgery Day?" — A Step-by-Step Guide

You'll be asleep during the procedure, so you won't feel any pain. Most patients are walking the very next day.

Last week, we covered how to prepare for surgery. This week covers what many of you want to know most: what happens on the day of surgery, hour by hour. Once you know what to expect, much of the fear goes away.

The Day Before: Admission

Morning to Afternoon: Checking In

• You'll be shown to your ward and assigned a bed
• A nurse will check your belongings and review your medications
• Bring your complete medication list. If you take blood thinners, they may have been stopped in advance

Afternoon: Final Tests and Explanations

• Final checks: blood tests, ECG, chest X-ray
• Anesthesiologist consultation: You'll be told what to expect with general anesthesia and asked about allergies and any previous anesthesia experiences
• Surgeon's final briefing: The procedure, the risks, and the consent form to sign
• If you have any remaining questions, this is the time to ask

Evening: Fasting Begins

• No food after approximately 9 PM (exact times vary by hospital)
• Clear fluids are usually permitted until 2 to 3 hours before surgery (confirm with your nursing team)
• Why fast? To prevent stomach contents from entering the lungs during anesthesia

Many people have trouble sleeping the night before. If you really can't settle, ask your nurse; a mild sleep aid may be available.

Surgery Day: Morning

Waking Up and Getting Ready

• You'll change into a hospital gown (front-opening)
• Remove all jewelry, dentures, contact lenses, and hair pins
• You'll put on compression stockings (to help prevent blood clots)
• Your IV line will be started

Heading to the Operating Room

• When it's time, a nurse will accompany you to the OR
• You may walk there or be transported on a bed
• Family members can usually accompany you to the OR entrance to say a few words of encouragement

Inside the Operating Room

When You Arrive

The operating room is a bright, spacious room. There will be many machines, but they are all there for your safety.

• You'll lie down on the operating table
• Heart monitors, blood pressure cuffs, and oxygen sensors will be attached
• Several staff members will confirm your name and the surgical site (a standard safety procedure)

Anesthesia Begins

1. The anesthesiologist will speak to you first
2. An oxygen mask is placed gently over your face
3. The anesthetic flows through your IV
4. "Take a few slow, deep breaths..."
5. Within seconds, you drift off to sleep

"I fell asleep before I even realized it." Almost every patient says this.

While You're Asleep (You Won't Feel a Thing)

The surgical team follows these steps:

1. You're positioned face down
2. The surgical site is cleaned and draped in sterile coverings
3. The surgeon uses a surgical microscope for magnified, precise work
4. A nerve monitoring system tracks nerve function throughout the entire procedure
5. A skin incision is made, muscles are gently moved aside to reach the bone
6. Bone and thickened ligament are carefully removed, freeing the compressed nerves
7. The team confirms adequate decompression and stops any bleeding
8. For fusion surgery, screws and rods are placed at this point
9. The wound is closed with sutures and covered with a dressing

Typical surgery duration:

• Decompression: 1 to 2 hours
• Fusion: 2 to 4 hours
• Blood loss: Usually minimal (blood transfusion is rarely needed)

Right After Surgery: Recovery

Waking Up

• You'll wake up either in the operating room or in a recovery room
• You'll feel groggy at first. This is normal
• A nurse will say something like, "The surgery is finished. You did great."
• Pain medication will already be working, so severe pain is uncommon

Common Sensations

• Sore throat (from the breathing tube; settles within 1 to 2 days)
• Feeling cold (operating rooms are kept cool; you'll be given warm blankets)
• Nausea (a side effect of anesthesia; anti-nausea medication is available)
• Wound soreness (treated with pain medication; tell the staff instead of putting up with it)

Your Family

• After surgery, the surgeon will speak with your family about how it went
• "Everything went well. The nerve compression has been relieved."
• When you can see visitors depends on the hospital's policy

The Evening After Surgery

• You'll rest in bed for the remainder of the day
• Your IV continues
• Pain medication (IV or suppository) is given at regular intervals
• Nurses will check your vital signs (blood pressure, pulse, temperature) every 2 to 3 hours
• They'll also check the sensation and movement in your legs
• A urinary catheter takes care of bathroom needs

The first night after surgery can be hard. Pain, unfamiliar surroundings, and adrenaline may keep you awake. This is completely normal. Don't force yourself to sleep. Rest will come over the following days.

The Next Day: Walking Already?

Yes — most patients begin walking the day after surgery.

This surprises many people, but early mobilization (getting up and moving early) is standard care in modern spine surgery.

• With a nurse watching over you: sit on the edge of the bed, stand up, take a few steps
• You may feel unsteady at first. That's fine; you'll have support
• The urinary catheter is removed, and you can begin using the bathroom independently
• If there's no nausea, eating resumes the next day

Why Start Moving So Soon?

• Blood clot prevention: Lying still for too long increases the risk of clots in the legs
• Pneumonia prevention: Moving helps you breathe more deeply
• Muscle preservation: Muscles can lose 1 to 3% of their strength per day of bed rest
• Faster recovery: Patients who move early recover faster overall

Days 2 Through Discharge

Before going home:

• Instructions on what to watch for at home
• Your next follow-up appointment is scheduled
• Pain medication is prescribed
• A rehabilitation plan is established

A Note for Family Members

Surgery day is an anxious time for families too.

• During surgery, you'll wait in a designated waiting area
• Surgery may take longer than expected (because of scheduling or extra care during the procedure). This doesn't necessarily mean something went wrong
• When you first visit after surgery: Your loved one may look pale or confused. This is normal as anesthesia wears off
• A simple "You did great" means a lot

Key Takeaways

• Day before: Admission, final tests, fasting begins
• Morning of surgery: Hospital gown, IV, then to the operating room
• During surgery: You sleep through it all. Nerve monitoring keeps you safe
• Right after: You wake up in the recovery room. Pain medication is already working
• Next day: Most patients begin walking (early mobilization is the key to recovery)
• Discharge: About 1 week for decompression, 2 to 3 weeks for fusion