Immediately following surgery, you will be transferred directly to the intensive care unit (ICU), usually with a breathing tube still in place. Your anesthesia will not have worn off, so you likely will wake up in the ICU after surgery.
While in the ICU, the nursing staff will constantly monitor your vital signs, chest tube drainage, breathing status, lab test results, and pain level. The anesthesia medications will be weaned gradually over the first couple of hours, in hopes of having you awake and off of the breathing machine within a few hours after your operation.
Even though you still may be asleep, your family or close friends will usually be able to visit you once the nurses have completed their initial intake evaluation and your vital signs are stable. This depends on each hospital and its ICU policy for visitors.
IN THE HOSPITAL
When you are awake and able to breathe on your own, the breathing tube will be removed. This is called being extubated. After the tube is removed, you will be monitored closely to make sure your breathing is normal. Usually this happens a few hours after surgery, but can be delayed depending on the status of your heart, concerns over blood pressure or bleeding, or your ability to breathe on your own after the operation. Delays in extubation are not necessarily concerning, depending on their cause. Every patient wakes up from heart surgery in their own way, and variations sometimes can be expected, especially if you have preexisting lung or kidney disease, or decreased heart function.
Once you are extubated, you will be encouraged to participate in breathing exercises. You also will be asked to communicate your pain level with your nurse so that your medication can be adjusted if necessary. It is very important to breathe deeply and cough (against a firm pillow) frequently after surgery because your lungs were not being inflated and deflated while you were on the heart-lung machine during the procedure. Taking deep breaths can help your lungs fully inflate and will help prevent complications like pneumonia or fluid build-up around them. Once you are ready, your nurse will help you out of bed to a chair and you will be able to start walking. Early activity is important to help reduce surgical complications, such as pneumonia, blood clots in your legs, and muscle weakness.
Once your surgery team feels that you are ready, you will be transferred from the ICU to another unit in the hospital.
Over the next few days, you will be working on recovering in the hospital. The goal is steady forward progress every day until you are comfortable and strong enough to leave the hospital. Your hospital recovery may include daily labs and chest x-rays, walking in the hallways, removing your drainage tubes, and monitoring your vital signs, glucose, and breathing status.
Your urinary catheter will be removed so that you can urinate on your own, but you may be constipated (difficulty having a bowel movement) after surgery. This is due to a number of factors, including your narcotic pain medication, your anesthetic, and not eating much. Do not be surprised if it takes 3-4 days after surgery to have a bowel movement.
Your surgeon and his/her team will determine when you are able to go home. This generally this occurs when:
- Your pain is controlled with pain pills and you do not require IV medications to control your pain
- You are able to walk to the bathroom with assistance
- You are breathing well and able to be weaned off supplemental oxygen
- You are stable on your current medication regimen
- Your lab results are stable and chest x-ray is satisfactory
- Your chest tubes and temporary pacing wires have been removed
- Your vital signs are within a normal range
This list is not exhaustive and there are many exceptions to each of these items depending on your individual condition.
Not all patients can go straight home after leaving the hospital. Some may require a skilled nursing facility for transitional care or further inpatient rehabilitation. If it turns out that you need more care once you leave the hospital, your team will ask a discharge planner to evaluate you and arrange for the resources that you need.
LEAVING THE HOSPITAL
If you do go home there are a few basic rules to follow after heart surgery:
- Do not drive for 1 month – The motions and position of driving have the potential to put too much pressure on your sternum (breast bone) while it is healing. And, if you need to stop suddenly and brace yourself against the steering wheel, injury to your sternal closure might occur.
- Do not lift, push, or pull more than 10 pounds for 6 weeks – This also puts too much pressure on your sternum, which is healing like a broken bone.
- It is okay to shower – Gently use soap and water over your incisions and gently pat them dry. It is okay if shampoo or conditioner gets on the wound, just rinse it off. After a shower, pat your wound dry instead of rubbing against it.
- Do not soak in a bath, pool, or hot tub until your wounds are healed completely — Soaking the tissue as it’s healing could introduce bacteria from the water into your incision.
- Monitor your incision – If you notice any redness, drainage, swelling, or separation of your wound, notify your surgeon right away. Also, notify your surgeon if you have a temperature greater than 101 degrees Fahrenheit or notice excessive chills or night sweats.
Once you are home, try to get back to your normal routine as much as possible while keeping the above restrictions in mind.
Walk at least a few times a day for as long as you can. Though there is no upper limit on walking, do not overdo it, wear yourself out, or walk so far that you can’t get back. Once again, the goal is steady forward progress until you are back to normal. There is no such thing as a record speed to recovery, and doing too much too early may actually set you back.
It is a good idea to have someone with you when you are walking outdoors in case you have any difficulty. Stairs should not be a problem, just take them slowly and take breaks on your way up if needed. Be cautious about pulling too hard on the railing so you don’t put extra stress on your sternum.
You likely will be scheduled to see your surgeon within a couple weeks after surgery. This usually is a quick appointment when your surgeon will remove the stitches from your chest tubes, examine your incision, and address any concerns you have regarding your recovery. You also should see your heart specialist within a few weeks of discharge, as well as your primary care physician for any additional follow-up. It is important to continue regular appointments with these physicians to make sure your recovery stays on track.
Recovery time after open heart surgery is about 6-8 weeks. During this time you likely will feel tired easily, and you may have some pain and soreness or muscle tightness. Your appetite also likely will be limited, and you may experience swelling in your legs or feet, trouble sleeping, and constipation.
All of these are normal parts of recovery from heart surgery. However, don’t hesitate to call your surgeon’s office if you are concerned that you are not recovering normally, or are bothered by a particular issue.
It is common to feel depressed or sad after heart surgery, especially following your discharge from the hospital. Heart surgery takes an emotional toll on everyone in one way or another. It can take many forms, including sadness, fear of complications, feeling tired, lack of energy, inability to sleep, and poor appetite. These things frequently don’t become apparent in the energetic and positive environment of the hospital, where you will get more than enough support and encouragement. Once in the familiar and quieter environment of home and your normal life, it is common to be thoughtful and sometimes depressed about what you have been through. This generally improves as you heal and see yourself getting back to normal. If these feelings last longer than a month or two, or are keeping you from recovering, don’t hesitate to speak with your primary care physician. You may resume sexual activity when you feel comfortable, but make sure that you are not putting pressure on your sternum.
Feel free to address any of these concerns with your surgeon. Urgent problems that need immediate attention include:
- Chest pain (similar to heart-attack pain) that is different from pain at your incision
- Shortness of breath that is not relieved by rest
- Blood in your bowel movements
- Coughing up bright red blood
- Heart rate faster than 150 beats per minute with shortness of breath or a new irregular heart rate
- New onset of abdominal pain, nausea, vomiting, or excessive diarrhea
- Sudden numbness or weakness in arms or legs
- One sided facial droop or slurring of words
- Sudden, severe headache
- Any significant changes in your wound, including redness, drainage, or separation of the edges
Should any of these issues occur, please seek help immediately.
POSTOPERATIVE ARM OR HAND SYMPTOMS
Though relatively rare, some patients complain of pain, numbness, or tingling in their hands or of arm and hand weakness after heart surgery. It can occur in one or both arms. This usually is the result of injury to the brachial plexus, which is the main nerve trunk that provides both sensation and muscle function to the arms and hands. It tends to happen most in patients with preexisting neurologic issues, including those associated with diabetes. It occurs because the nerves of the brachial plexus can sometimes be stretched or pinched during heart surgery that has been performed via the median sternotomy incision (midline incision with division and spreading of the breastbone). Patient position on the operating table during the operation also can contribute, which is why the operating room personnel go to great lengths to both position patients carefully and to pad their arms and elbows to prevent nerve injury.
Brachial plexus injury after heart surgery is rare, but can be seen in a couple of different forms. The most common form causes numbness in the hands, usually in the third, fourth, and fifth fingers. The outlook for this type of injury is usually quite good, with symptoms resolving over 3-6 months. If you experience pain, numbness, or weakness in your hands or arms after heart surgery, it important to let your surgeon know. Though most symptoms usually resolve, it may be that referral to a pain specialist or for physical therapy and more extensive evaluation may be necessary.
Usually, patients can take up to 6 weeks off work and be covered for disability, but be sure to speak with your company’s human resources department before surgery to ensure you fully understand your coverage.
GOING BACK TO WORK AND DIET
You can go back to work earlier if you feel able, but keep in mind you cannot drive for 1 month, so you may need to find another way to get to and from work. It also is important to be off all narcotic pain medications prior to going back to work or driving. If your employer allows it, try going back part time or with light duty as a transition back to full-time work. Also ensure that you are also not lifting anything heavy for 6 weeks after surgery.
A high protein diet may be recommended for you following surgery because proteins can help your body heal faster; however, any previous diet restrictions that you had before surgery, such as a low-salt diet, low-cholesterol diet, diabetic or renal diet, likely will still be required after surgery. These guidelines have not changed!
Contact your heart specialist for specific heart healthy diets. If you are overweight, weight loss is important, but immediately after surgery you want to make sure you are getting enough calories, protein, and water to allow your body to heal. Also, be sure you do not combine alcohol or other mind-altering drugs with narcotic pain medications.
Everyone responds differently to surgery, medications, and recovery.
If you have any questions at any point in your heart surgery course, always reach out to your heart specialist or surgery team to address your concerns. The better educated you are about what to expect and how your body heals, the better you can expect to recover from surgery. Always defer to your cardiothoracic surgeon’s guidelines for you, though, because they are tailored to your specific requirements. Be sure to ask questions and clarify any information that is unclear so that you can be better prepared for your surgery and recovery.
For more information, you can print this brochure, “What to Expect After Heart Surgery”.
Reviewed by Robbin G. Cohen, MD, MMM