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Thoracic Surgery Post-operative

Date issued: March 2023

Review date: March 2025

Ref: A-576/AM/Physiotherapy/Thoracic Surgery Post-operative

PDF:  Thoracic Surgery Post-operative final March 2023.pdf [pdf] 310KB

Introduction to the Thoracic Centre

Welcome to the South West Cardiothoracic Centre at University Hospitals Plymouth NHS Trust.

This booklet aims to improve your understanding of the operation you have had, what to expect whilst you are in hospital following your surgery and how to continue your recovery at home.

Use this booklet along with the advice you receive from your healthcare team.

The multidisciplinary team who will be involved in your care include the surgical team, therapists and ward staff.

Types of Lung Surgery

Wedge or segment resection:

Removal of a small piece of lung tissue

Lobectomy:

Removal of a whole lobe

Pneumonectomy:

Removal of a whole lung

Accessing the lung for surgery

Thoracotomy

This is an open incision made around the side of your body, below your shoulder blade and between the ribs. The ribs are then spread to get access to the lungs and remove the lung tissue.

Video-assisted or robot-assisted Thoracoscopic Surgery

Small cuts of approximately 1-5cm are made under the arm and/or below the should blade. The ribs are not spread. Small surgical tools along with a camera are inserted to remove the lung tissue.

Your attachments after surgery

Chest drains remove fluid and waste from the site of the surgery. They are removed when drainage becomes minimal and there is no air leaking from the lung.

Your pain relief will include a local anaesthetic infusion (LAI) which is put around the surgical incision to numb the pain. Patient controlled analgesia (PCA) allows you to control your own pain relief. The button will turn green every 5 minutes, indicating that you can have a dose of pain relief.

It is not possible to overdose from the PCA as it is delivered in small doses. It’s important to use your PCA so you can cough and move around.

Post-operative Physiotherapy

Maintain your strength

Immobility can quickly lead to muscle weakness and joint pain. Moving early on after the surgery can prevent this. It also helps the digestive system to return to normal and prevents blood clots forming.

Improve your breathing

Moving around helps to improve your oxygen levels, stop your lungs collapsing and reduces the risk of developing a chest infection. You will be provided with a spirometer and taught breathing exercises.

Give reassurance

Pain, anxiety and mood swings are common experiences after surgery. The physiotherapists can help talk through your concerns and give you advice.

Provide assessment

Physiotherapists will assess your mobility and ability to self-care as soon as possible. This is to identify if you need support, equipment, or rehab before your anticipated discharge date.

Using your incentive spirometer

You will be given an incentive spirometer. This device gives you feedback on how much you are able to deep breath. Try to complete 10 breaths every hour. Ensure you have used your pain relief button beforehand. This is so you can achieve effective deep breaths.

  1. Sit up straight in the chair. If you must stay in bed, sit fully upright.

  2. Hold the spirometer at eye level and seal your lips tightly around the mouthpiece.

  3. Breath in slowly and deeply. Keep the small indicator within the window to check the speed of the breath. If it moves too high, you are breathing in too quickly.

  4. The piston shows how much air you are breathing in. You will be set a target with the adjustable marker.

  5. At the end of the breath, relax your mouth and move the mouthpiece away. Exhale slowly.

  6. Ensure the piston is at the bottom before taking your next breath. Stop if you feel dizzy or unmanageable pain.

Coughing and clearing phlegm

Coughing is very important to make sure phlegm does not get stuck in the lungs and cause a chest infection. Coughing will not cause any damage to your lungs or wound.

If your phlegm becomes thick or sticky, you may be prescribed nebulisers to help loosen up the phlegm or open your airways. The liquid is turned into a vapour, which you inhale directly into the lungs.

Some patients need more physiotherapy which focuses on clearing phlegm and improving lung function.

Use your pain relief button regularly to help manage your pain whilst coughing.

You can support your wound by tucking your elbow into your side or cupping your opposite hand on your side. Make sure you do this over your gown and do not directly touch the wound to avoid infection.

Physical activity in hospital

The sooner you mobilise after surgery, the sooner you will be fit to go home. You will have help with your attachments to start with, but once you can manage them by yourself, you will be encouraged to mobilise and self-care independently. Once your attachments have been removed, you will be asked to complete a stair assessment.

None of the types of surgery require you to restrict the movement of your shoulder or arms. Increase the amount you use your arms gradually and stop if it becomes uncomfortable. There are some exercises in this booklet to help with this. Follow the advice from your physiotherapist and nurse.

Leg Exercises

Your physiotherapist will check the following exercises are safe for you to practice. These exercises aim to keep your muscles strong and maintain circulation. Try to practice a set of 10 on each leg, 3 times a day, but stop if you feel lots of discomfort.

In lying or sitting, make circular movements of your ankle.

In lying (but propped up by pillows), squash your knee down into the bed. Hold this for 5 seconds.

In sitting, straighten your leg and lift it up. Hold each time for 5 seconds.

In sitting, bring your knees up and down alternately. Hold each time for 5 seconds.

Arm and shoulder exercises

After the surgery, it is common to experience discomfort on the side of the operation, but it is important to keep moving your shoulders to prevent joint stiffness. You will not do any damage to yourself by practicing these exercises.

Try to practice a set of 10 on each arm, twice a day, but stop if you feel lots of discomfort.

In sitting or standing, start by rolling your shoulders to loosen up the joints.

In either sitting or standing, bring your arm slowly out in front of you above your head. Hold this for 5 seconds, then slowly lower it back to your side. Repeat this again but lift your arms out to the side instead.

If you are finding these exercises difficult, use a wall to “spider crawl” your fingers up slowly, pausing regularly to stretch your shoulder.

Planning for home

Patients usually stay in hospital for between 3 and 7 days. This will depend on the type of surgery you’ve had, any complications and your physical progress on the ward.

Please tell us if you are worried about going home as soon as possible so we can prepare any support for you well in advance of your discharge. To help us with this, you will be asked to provide us with some information, such as:

  • Who you live with

  • What support you will have

  • What type of home you live in

  • What your fitness was like

  • The nature of your job

  • What hobbies you have

If required, you may be referred to an Occupational Therapist who can supply equipment and/or arrange for carers to support you at home.

If the surgical team are happy for you to leave the hospital, but you are continuing to need a lot of help, we discuss a referral to inpatient rehab with you.

We will ensure you are safe and have any support you need in place before discharging you from the hospital.

The day of discharge

You may be transferred from the ward to the discharge lounge on level 3 to wait for your family member or transport to collect you.

Your Physiotherapist will check that you:

  • Can walk independently (with or without a walking aid)

  • Can manage a flight of stairs (if you use them)

  • Can use your spirometer independently

  • Are aware of your exercise plan once home

  • Have any referrals to the community teams if needed

Your nurse will check that you:

  • Have all your medication and know how to take them

  • Are aware of any follow up for your stitches

  • Know how to manage your own chest drain if you are going home with one

Your surgical team will check that you:

  • Are passing urine and opening your bowels as normal

  • Are eating and drinking as normal

  • Can manage your pain

  • Have a copy of the discharge letter to be sent to your GP

  • Are aware of your follow up appointments

Physical wellbeing at home

It is common to experience low levels of energy and concentration, and an altered sleep pattern and appetite.

  • Establish a consistent day/night routine

  • Eat small light meals at your usual mealtimes, but don’t lift heavy pans

  • Continue to practice your exercises and spirometry regularly, and gradually increase the distance and pace of your walking

  • Take time to rest at regular intervals

  • Listen to your body and set achievable goals

Your wound

Use a mirror or ask a family member to check your wound each day. Do not touch it to reduce the risk of infection.

If it is clean and dry, it should be left without a dressing to help it heal more quickly.

Don’t use perfumed products or scrub the wound.

Wear loose comfortable clothes and avoid anything tight fitting or material that will irritate the skin.

Continue to take pain relief if its uncomfortable, especially if it’s preventing you from being active.

Recovery at home: Mental Wellbeing

As well as physical side effects, surgery can affect you mentally. It is normal to feel anxious, irritable, tearful or overwhelmed. Try and reconnect with your family, friends and hobbies as soon as you feel able.

Getting out in natural light and fresh air is good for overall wellbeing. Weather permitting, sit out in your garden if you have one, or pick a spot in your home that has natural light.

Try doing this “body scan” relaxation technique:

  • Find a quiet place to sit or lie down

  • Start at one end of your body and focus on that body part

  • Notice any areas of tension then soften and relax them

  • Continue until you have moved through your whole body

Getting a good night’s sleep is important in your recovery. To help with any discomfort, take pain relief and use extra pillows to prop you up, or put in between your knees. If pain continues to disrupt your sleep, please contact your GP.

Increasing your physical activities

The rate at which you will get back to your previous fitness levels will depend on factors such as your physical abilities before the surgery, the amount of lung tissue you had removed and if you have any other health conditions. It is normal for the lung to take between 3 and 6 months to fully heal.

Increasing the pace and distance of your walks over time. Introduce hills or inclines as you feel able to. Pick routes that have places to rest. It is better to do a short walk each day, instead of long walks less often.

Some breathlessness is expected but should improve over time. If you are not able to go outside, you can do a basic aerobic session indoors. An example of a short programme is on the next page.

If your symptoms persist, talk to your GP, especially if you develop increased pain, swelling or redness around your wound or if your energy levels, mood and sleep disturbances are not improving.

Please ring 999 if you suddenly become very short of breath or experience sudden and intense central chest pain.

Home exercise programme

These exercises aim to maintain the strength in your lower body and improve your balance. Aim to repeat each exercise 10 times. Stop if you become too breathless, or if you feel a sudden onset of pain.

Stay close to a stable surface to keep your balance to start with then aim to reduce the use of the surface to challenge your muscles.

  1. Warm up by marching on the spot for 5 minutes.

  2. Raise your heels off the ground so your weight is on the front of your feet. Hold for 3 seconds

  3. Using an aerobic step (if you have one) or the bottom step of your stairs, practice stepping up and down.

  4. Practice going from sitting to standing. Do this slowly and reduce the use of your arms to challenge your muscles more.

  5. Using the back of a chair for support, bend your knees and squat down, holding that position for 3 seconds.

Keeping a diary

Some people find keeping a diary can be a positive source of motivation and recognition of your progress both physically and mentally.

Write down a few words about what you have achieved each week, and then what you would like to achieve the following week.

Use the following table to log your activity and rate how you’re feeling on a scale of 1-10

(1 = very poor, 10 = excellent).

Diary

 

M

T

W

T

F

S

S

No. of walks

 

 

 

 

 

 

 

Total time walking

 

 

 

 

 

 

 

Total distance

 

 

 

 

 

 

 

Exercises completed

 

 

 

 

 

 

 

Spirometry completed

 

 

 

 

 

 

 

Sleep quality

 

 

 

 

 

 

 

Energy level

 

 

 

 

 

 

 

Appetite level

 

 

 

 

 

 

 

Mood

level

 

 

 

 

 

 

 

Resuming work and hobbies

Driving

Do not drive until you have been reviewed at your outpatient appointment. This is usually 4-6 weeks after your surgery. To start driving again you must be able to wear a seatbelt, make an emergency stop and be able to twist in order to check blind spots and reverse. Check your motor insurance to make sure your policy still covers you after surgery.

Sport

Light sports such as swimming, cycling, golf, bowls or fishing can be resumed 8-12 weeks after surgery. For contact or more intense sports such as tennis, football or rugby, please discuss this with your surgeon.

Return to work

The demands of your job will influence when you will be able to return to work. It is best not to start working again until you feel completely well. Discuss with your employer if you can do a phased return or light duties. If you are self-employed, or carry out heavy manual labour, please discuss with your surgical team for advice.

Sexual activity

There are no definitive rules about this but allow 2-4 weeks for your body to recover. It is unlikely you will do any damage following the surgery. Choose a position that is comfortable, does not restrict your breathing or put excessive strain on the wound.

Flying

It is recommended that you do not fly for 6 weeks after surgery. If you have had a whole lung removed, this will be 6 months. If you wish to travel before this, please speak to your surgical team who can give you advice.

Holidays

For the first 6 months after surgery, if you wish to travel abroad, it is advised to plan a relaxing holiday with minimal travelling. Use complete sun block over the wound scar for the first six months after surgery. Make sure you have comprehensive insurance, which may alter due to your treatment. There are specialist insurance companies that can help with this.

Notes:

Your surgery:

Your consultant:

Ward contact details:

Other information:

With additional thanks to:

Scottish Lung Cancer Nurses’ Forum

Leeds Teaching Hospitals NHS Trust

Roy Castle Lung Cancer Foundation

Cardiothoracic Physiotherapy Team

The staff of Crownhill Ward

 

Southwest Cardiothoracic Centre

University Hospitals Plymouth NHS Trust

Terrence Lewis Building

Derriford Hospital

Derriford Road

Plymouth

PL6 8DH

 

Tel: 01752 202082

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