So you are going to have open heart surgery, what’s next?
How to prepare the day before surgery: Always get a restful night’s sleep and eat a healthy meal. You should not eat or drink anything except small sips of water with your medications after midnight on the day before surgery.
What to expect during your hospital stay: The day of surgery you will meet your anesthesiologist and your operating room nurse. They will take great care of you and ensure your comfort until it’s time to go to sleep. Patients are placed under full anesthesia which includes a breathing tube. Most surgeries range between 4-6 hours in duration. After the surgery, you will wake up in the intensive care unit. There you will meet your ICU nurse and the team of doctors, physician assistants, nurse practitioners, dieticians, and therapists who will be taking care of you. Once you’re fully awake, we can remove the breathing tube and you can start to drink sips of water and ice chips. We encourage early mobilization from day 1 so you can expect to be up in a chair and walking within the first 24 hours of surgery. Because the breastbone is divided in surgery, it’s normal to have pain in the middle of your chest, along your back and in your sides. We also place drains in surgery which will be removed 1-2 days later. Removal of the drains helps allow for deeper breaths and can alleviate some of the pain. Coughing and sneezing tend to exacerbate the pain so we give you a heart shaped pillow to hug while coughing or sneezing to help ease the discomfort. That heart pillow and your incentive spirometer will be your best friends for the next month! Most patients spend 1-2 nights in ICU and then move to the telemetry floor. Here you will continue to walk around in the hallways and do breathing exercises to get your lungs back in good shape. We cannot stress how important it is to walk and sit in the chair for all of your meals early on, not only does it prevent respiratory complications it also helps relieve some pain. Your providers will be making medication adjustments, monitoring your vitals and preparing for your discharge. Most people go home on discharge with a family member or friend to help. Occasionally, if you’re still too weak to walk independently or you have other therapy needs we can make the necessary arrangements for you to go to more intensive rehab. The average hospital length of stay is about 4-7 days.
Yay, I’m going home, now what: When you’re released to go home we expect you to continue to walk at least 3 times a day, sitting up in chair – not lying in bed all day! Walking at least 30 minutes of day is a good rule of thumb. Initially, patients feel weak and tired but as you mobilize and participate in rehab you'll feel your strength return gradually. We want you to get back to your normal routine in about 4-6 weeks. Activity restrictions include no lifting/pushing/pulling greater than 5-10 lbs. and no driving for 4 weeks from surgery. We will see you in our clinic 1 week and 1 month after discharge. Call us at 214-820-7100 or visit our clinic if you have any questions about your recovery. If you develop fevers, incisional redness or drainage, or significant swelling in your legs and weight gain call the clinic so we can address these issues. And remember, if something doesn’t feel right and you cannot wait call 9-1-1 for emergencies.
1. I’m having pain what should I do?
a. Ask the staff prior to trying Tylenol and Ibuprofen if not on any other prescription pain pills
i. Alternating them is helpful so taking 325mg every 4 hours and then taking ibuprofen 200mg every 6 hours.
ii.Heating pads are also very helpful for local pain control
2. What medications can I expect to be on after heart surgery?
a.Most cardiac surgery patients are on 4 medications: aspirin, cholesterol lowering medication (“statin”), heart lowering medication (“beta blocker”) and a blood pressure lowering medication
3. How do I take care of my skin incisions?
a.Some drainage from the incision is ok
i.Monitor temperate with a thermometer
ii.If you are changing the bandage or dressing on your wound site 2-4 times every hour then it is a problem! Call 214-820-7100
b.Plain bar soap and water is great for the incision
i.Avoid fancy shower gels and loofahs
c.Leave the incisions open to air
i.Moisture can be a nidus for infection!
d.Avoid scar removing agents and lotions where the incision is still healing
4. When will my post-operative visit be and what should I expect?
a.Bring a daily log of your temperature, weight, blood pressure, and heart rate
b.Usually record your blood pressure and heart rate two times a day
c.Bring all of the medications you are taking to the office (or take a picture of all the bottles and bring them to the office)
d.Come 30 minutes earlier than the appointment time to have time to get the chest xray
e.Office visits are 1 week, 1 month and 3 months after discharge from the hospital.
5. When will cardiac rehab start?
a.Explore locations near your home!
b.You will usually start cardiac rehab after the first office visit.
c.Cardiac rehab is important to ensure a safe transition for strength and conditioning after surgery.
6. What other follow up appointments should I make?
a.Make sure to make an appointment with your Primary Care Doctor within 2 weeks to 1 month from discharge to discuss medication changes and updates.
i.Give the Primary Care Doctor our fax number 214-820-6863 so we can fax hospital reports to their office
b.Make sure to make an appointment with your Cardiologist within 4-6 from discharge to discuss medication changes and updates.
a.Call us at any time 214-820-7100. We are at your service and can help you with your questions!
This post was written by:
Anju Garg, MPAS, PA-C
Senior Cardiac Surgery PA
Baylor Scott & White Health