Your primary care physician (PCP) will receive a complete summary of your hospital stay, condition and medications. A follow-up visit with your surgeon must be scheduled three to six weeks after surgery. Before you leave the hospital after your surgery, you will receive instructions about follow-up visits with your primary care physician and/or cardiologist.
When you are stable, you will be encouraged to become more active and participate in the first phase of cardiac rehabilitation. A physical therapist will discuss activity guidelines while you are in the hospital and for when you are at home. Cardiac rehabilitation will help increase your mobility, improve your strength and endurance and teach you to monitor yourself during exercise.
Your care team will teach you how to get out of bed without putting pressure on your sternum and provide assistance using the restroom and walking around the halls. You will also be encouraged to begin taking meals outside of your bed, in order to gradually increase your activity.
Your care team, including a discharge nurse, will give you specific instructions to prepare you for your return home. Your family members and/or close friends may be present at this time to help prepare you to return home and to find out how they might help in the recovery process.
You will likely receive a call within 48 hours of your departure to review discharge instructions, discuss your concerns, answer questions, discuss your medications and ensure you have scheduled your follow-up appointments. At this time, you might also be able to schedule your follow-up appointments.
If you have any questions before the discharge nurse calls you, call your surgeon’s office.
For some time, you may not have much of an appetite and may be encouraged to eat small meals with high calorie and protein content. As you heal and your appetite improves, it will become more important to avoid excessive calorie intake and focus on making heart-healthy choices.
After surgery, many people have a rise in their blood sugar level (even if they are not diabetic). Your care team will check your blood sugar frequently. Some patients may need insulin to correct blood sugar levels. This may be on a short-term basis or may continue when you go home. A diabetes expert will work with you to develop a treatment plan, if necessary.
When your care team determines that you are ready to leave the ICU, you will be transferred to a step-down unit. This is usually within one to two days after surgery and is dependent upon your condition. Your care team will minimize the number of moves that are necessary, but you may need to move more than once.
Your safety is top priority, and the processes in place are to ensure minimal disruption and seamless transitions. One of the ways your safety is ensured is by checking your medications frequently, so you may be asked about them on a regular basis during your stay.
Each person feels pain in a different way. Your pain can be physical, spiritual or emotional. All pain is real, and only you can tell your healthcare team how you feel.
It is normal to experience pain after surgery, and your care team can help you choose the best treatment. Please notify your care team about the level of pain you have so that medication can be administered. You may be asked to rate your pain by using a scale of zero to 10, zero being the lowest amount of pain and 10 being the highest amount of pain. Pain-relieving medication may be given orally or intravenously and will help keep you comfortable.
Medication for managing your pain is essential because it allows you to actively participate in your recovery.
Some common types of pain after surgery are:
- sore throat following removal of the breathing tube
- soreness of the chest caused by increased activity or coughing
- discomfort, tightness, soreness and numbness around the incision areas and in the legs and arms
- bruising, redness and tenderness around the incision areas
It will take about 6 to 12 weeks for the incision areas to heal completely. Some pain will gradually go away as you become more active. Changing positions, elevating swollen legs and practicing relaxation techniques will aid this process.
The breathing tube will stay in place until you are awake and alert enough to breathe on your own. This may take four to five hours after coming out of the operating room. You may not have anything to eat or drink while the breathing tube is in your throat. Your care team will provide moist swabs for your mouth to help with the dryness.
After the breathing tube is removed, you will be given a device called an incentive spirometer (IS) to help exercise your lungs and encourage you to take deep breaths. Your care team will ask you to work on your IS 10 times each hour while awake. Slow, deep breaths are important in preventing pneumonia and weaning from oxygen.
At this time, you may also start eating and drinking at your care team’s discretion. It is best to start with ice chips and then to move to clear liquids before eating solids. It is normal to have a decreased appetite, even nausea. This should go away in a few days.
Chest tubes (inserted to drain extra fluid around your heart during surgery) will typically be removed one to three days after your procedure. They are connected to a container, and you may feel some tugging under your skin. The chest tubes are often a source of pain, but this can be relieved with medication. It is important to tell your care team when you experience pain so that you can be properly medicated.
The urinary catheter is removed within a day or two after surgery. If you have pacemaker wires, these will be removed before you are discharged.
When you are settled in your room, the nurse will inform your loved ones that they can see you.
Typically, you are asked to limit the number of family and friends that visit in the ICU. Your body needs time to rest and rebuild your strength. Having surgery is exhausting, and you may fall asleep while your visitors are with you. This is normal and should be expected.
Before your surgical procedure, you will receive a prescription for an antibiotic ointment that should be started five days prior to surgery. This ointment is a safety measure to help prevent infection. Make sure that you follow the instructions that come with the prescription.
You are required to shower or take a bath on the day prior to surgery both in the morning and at night and again the morning of your surgery, before coming to the hospital. Specialized bathing should be performed a total of three times, following these instructions:
A special antibacterial liquid soap should be applied with a clean washcloth and lathered over the entire body, with an emphasis on the operative sites (chest wall in the front and legs) as well as your scalp, around the nose, armpits, navel and genital areas. After washing, rinse thoroughly. Repeat the process three times at each bathing. Dry with a clean bath towel.
1 AnswerAt your presurgery visit, your care team will review your history, perform a physical exam, review your medications and allergies, and provide information on your surgery and any clinical trials that may be relevant to you. Your medical history and current state of health will be updated regularly to determine if any changes are warranted in your care plan.
You will receive detailed instructions on what studies to send to the surgeon’s office or to bring with you on the day of your appointment. It is very important for your surgeon to review these studies at your visit. Without the proper studies to review, your appointment may need to be canceled and rescheduled for a later date.
During your outpatient visit, you will meet your surgeon, the administrative assistant, and a nurse practitioner. You may also meet a member of the research team.
After examining your symptoms and diagnosis, a care plan will be developed based on your individual needs. Your care team will also help with the coordination of office visits and the scheduling of your surgery. Your surgery will most likely be scheduled during your outpatient visit. If your surgery is scheduled more than 30 days after your visit, you may need to return before your surgery. This will allow your care team to ensure that they have the most current information, and they will update your history and physical exam to determine whether any changes are warranted in your care plan.
Your care team will help you prepare for surgery and review detailed instructions that are specific to your condition, preadmission testing, medications, preoperative preparation, and expected length of stay. The length of time you will be in the hospital depends on the type of surgery you are having and other factors.
The day before your surgery, you will receive a call late in the day with instructions on when to come to the hospital and where to go.
In the event of an emergency or unforeseen circumstance, your surgery may need to be postponed or canceled. Typically, in such a case, every effort is made to reschedule as soon as possible.
2 AnswersCraig Smith, Cardiothoracic Surgery, answered on behalf of Columbia University Department of Surgery
A LVAD (Left Ventricular Assist Device) can keep a failing heart pumping -- but it used to carry a significant risk of stroke. Improvements have whittled that risk down, but there are still dangers. Watch this video with cardiothoracic surgeon Craig Smith to learn about the subtle but important risks that come with the latest generation of pumps.