After Open-Heart Surgery: In the Hospital

The length of your hospital stay after open-heart surgery depends on what type of surgery you had and your needs. It may be as short as 3 to 4 days. If you have complications, you may stay in the hospital for several weeks or longer. Read on to learn more about what to expect during your recovery in the hospital after open-heart surgery.

Right after surgery

After your surgery, you will be moved to a recovery room where you will be watched closely. When you first wake up, you may expect the following:

• You may feel very sleepy, thirsty, or cold, and sick to your stomach. It is also common to be confused and disoriented for a time after heart surgery.
• You will have a tube in your throat that is connected to a ventilator to help you breathe. You will not be able to talk while the tube is in place. The tube will be removed as soon as you are awake enough to breathe on your own and it is safe to do so (usually within 6 hours). 
• You will have an IV (intravenous) line in your arm or hand to get fluids and pain medicine. You will also most likely have an IV in your neck. It is also used to give you fluids and medicines and to measure pressures inside your heart to help you recover. You will also have an arterial line, usually in your wrist artery (radial artery) or in the groin/upper inner thigh (femoral artery). This is to monitor your blood pressure and to take regular blood samples.
• You will be connected by wires to several machines. These monitor your heartbeat, temperature, blood oxygen level, and other vital signs. You may also have a small pacemaker attached to temporary pacing wires. This is in case you have a slow heart rate or certain irregular heartbeats (arrhythmias) that need a pacemaker.
• You will have tubes (drains) in your chest to remove air and fluid, and to help re-expand your lung.
• You will have a tube (catheter) to drain urine from your bladder.
• You may have a tube in your stomach to help prevent bloating and vomiting. It will be removed when the breathing tube is removed.
• Family members may be able to visit you after surgery. They should know that you will have tubes and wires connected to your body. You may look pale, and your face and body may look very puffy. This is all normal. You will not be able to talk to them because of the tube in your throat but a nurse can help you communicate if you need to.

The next few days

• A nurse will always be available while you are in the hospital and you will be monitored at all times.
• Even if you are not diabetic, the nurses will check your blood sugar regularly. Depending on what your blood sugar levels are, you may need to be given insulin intravenously (IV) or by injection. This is very important to reduce the risk for complications, especially infection.
• You will get pain medication, but you may still feel some pain. Tell a nurse right away if you do. Do not wait until the pain gets bad to mention it.
• If you still have a breathing tube in your throat, it will be removed when you can breathe on your own. When the breathing tube is removed, may get oxygen through a mask or small prongs in your nose. Other drains, tubes, wires, and monitoring devices are removed when you no longer need them.
• You may hear or feel clicking in your chest when you breathe or move. This is normal and will go away with time. The breastbone was cut (separated) during surgery to allow the surgeon to reach your heart. Afterward, it was rejoined with wires. After the breastbone heals, the noise should go away.

Managing pain

You will be given medication to help you manage your pain after surgery. You may be given oral pain medication on a regular schedule or in some cases; you will give yourself pain relief through a PCA (patient-controlled analgesia) pump. This pump allows you to push a button to get a safe dose of pain medication that is delivered through an IV line. You can only get a certain amount of each hour, so you cannot get too much. Be sure to tell your nurse if your pain is not being controlled by your medications.

Breathing and coughing exercises

You will have some fluid in your lungs after the breathing tube is removed. If this fluid collects in your lungs, you could develop pneumonia. To prevent pneumonia, a nurse or physical therapist will teach you deep breathing and coughing exercises. Do these exercises as you are told. Holding a pillow tightly to your chest when you do your exercises also helps.

For breathing exercises, you may use a device called an incentive spirometer. Using this device helps your lungs recover. There might be phlegm or secretions in your throat, especially if you smoke. It can sometimes be difficult to get the phlegm or secretions out of your throat, but it is very important to do so. Your healthcare team may give you breathing treatments containing special medicine to help you get rid of the phlegm.

Activity

You will receive rehab and be assisted out of bed as soon as your recovery allows (the breathing tube is out and your vital signs are stable).  This is usually on day 1 after surgery. You will see a physical therapist and will work together to develop a mobility and rehabilitation program.  This is a program of exercises and education. It will help you recover after surgery and regain strength. It will also help you reduce your risk for future heart problems. Moving around early in your recovery period helps your circulation, decreases soreness, and helps prevent blood clots and pneumonia. You may start by just sitting on the edge of the bed or moving with help from the bed into a chair. When you’re well enough, a staff member will help you get up and walk. At first, you will become tired easily. Tell the nurse if you feel dizzy or cannot breathe.

Eating

At first, you will be given only liquids to drink. This is to prevent vomiting. Then, when you are able to eat, you will be given solid foods although you may not have an appetite yet. You may feel nauseated or just have no desire to eat. This is normal. When you eat, you may also notice you have lost your sense of taste. This should go away in a few days or weeks as the anesthesia and pain medications wear off.

Pain medications can slow your bowels and make you constipated. You will be prescribed a stool softener and a mild laxative to move your bowels. If you continue to feel constipated, tell your nurse because other treatment options may be available.

Going home

Your doctor will tell you when it is okay for you to go home. Have an adult family member or friend ready to escort you home. In case you have problems or questions after the surgery you will be given contact numbers for both your healthcare providers and the hospital.

Before leaving the hospital, you will be given instructions for how to care for yourself at home. This includes caring for your incision and healing breastbone, taking medicines, and being active. You will also be given dates and times for follow-up appointments with your surgeon, cardiologist, and primary care provider. You may be told to continue cardiac rehab after leaving the hospital to help you continue to get stronger. This may last several days up to several weeks.