Frequently Asked Questions

Adelaide Cardiothoracic > Patient Information > Frequently Asked Questions

Before Surgery

Preparing for surgery

I have seen my surgeon and I need to have surgery. What happens next?

You may be given a date for surgery by your surgeon, or you may be placed on the public hospital waiting list to be notified in due course when the date of your surgery is determined. If you feel you are getting worse while awaiting your surgery, please contact us as soon as possible.

As part of your preparation for surgery, you may need to have particular tests (such as blood tests or scans) done; your surgeon will organise these for you. If you are having valve surgery, you may need to see a dentist prior to surgery to ensure there are no problems that could potentially cause an infection on your new valve after your procedure.

Either at the time of meeting your surgeon, or once your surgery date is confirmed after this, you should be given the date and time you are expected to arrive at the hospital and the details of any medications you need to stop prior to your procedure.

How long will I be off work?

Recovering from heart or lung surgery generally takes most people anywhere from four weeks to three months. Plan to be off work for between four and twelve weeks, depending on the type of work you do. Look into any sickness benefits that maybe available to provide you with support during your recovery. Although your surgeon will be able to give you some guidance, your GP and specialist physician may be able to best advise you on when you will be ready to return to work. For further guidance, please see our page‘When can I resume my usual activities?’ which may help you in better predicting the time you will require before being able to return to work.

How long will I be in hospital?

Your stay in hospital will depend on your operation, however as a guide, most patients stay between five and seven days in hospital after surgery.

What should I do if I am not feeling well before my surgery?

Call your GP or specialist physician if your symptoms change or worsen at any time while you are waiting for your surgery and let us know at Adelaide Cardiothoracic on 08 8375 5950 (during business hours) or email us at contact@adelaidecardiothoracic.com.au.

However, if you have significant symptoms which are not relieved by rest or your medication, call an ambulance, ask someone to take you to the nearest Emergency Department, or call 000.

What tablets do I need to stop prior to my operation?

You will need to stop blood thinning medications (except for Aspirin) prior to your surgery as blood thinning medications can cause increased risk of bleeding. It is important your doctor knows exactly what medications you are taking, including all over the counter supplements and medicines, as there are diabetic medications, and supplements such as fish oil or vitamin K that may also need to be stopped prior to your surgery. Your doctor will advise you exactly when you need to stop and when. If you have any questions leading up to your operation, call us at Adelaide Cardiothoracic on 08 8375 5950 or email us at contact@adelaidecardiothoracic.com.au.

Will I need a carer after my surgery?

We recommend you have a family member or friend stay with you each night for up to one week after you get home from the hospital. Arrange for help at home for daily activities such as cleaning, groceries, laundry, and gardening for six to eight weeks. Nursing and home care services are NOT routinely supplied, but are available if necessary. You should be able to care for yourself by the time you are ready to go home.

Can my carer have a sick certificate?

No, your carer can’t have a sick certificate as they are not sick. But our surgeons will be happy to write a note to your carer’s employer indicating that you are having surgery and need a carer.

What should I be aware of in the days leading up to my surgery?

Please notify us by calling Adelaide Cardiothoracic on 08 8375 5950 or email us at contact@adelaidecardiothoracic.com.au if:
  • you have any signs that may suggest an infection (e.g., fever or high temperature, cough, cold or flu symptoms, burning or pain on urination, or redness around cuts or scratches on your skin).
  • you need to defer surgery due to a change in your personal circumstances

How do I ensure my wishes are followed if I cannot make decisions for myself?

If there are complications during or after your surgery, you may not be able to make decisions about your own care. In the unlikely event that you are unconscious, are confused or delirious, have had a stroke, or need prolonged breathing support on a ventilator, it helps if you have given advance instructions about your wishes for your ongoing health care, living arrangements, and other personal matters, as well as nominating who you would want to help make those decisions for you.
Your surgeon and the other medical and nursing staff will always discuss important decisions with your family, but you can prepare ahead with an Advance Care Directive. This is a document that gives those who are caring for you a clear understanding of your needs and wishes should you lose your ability to communicate them yourself. An Advance Care Directive replaces any existing Enduring Power of Guardianship, Medical Power of Attorney, or Anticipatory Direction. It allows you to:
  • Write down your wishes, preferences, and instructions for your future health care, end of life, living arrangements and personal matters; and/or
  • Appoint one or more Substitute Decision Makers to make these decisions on your behalf, if you are unable to make them for yourself.
Having an Advance Care Directive will give you peace of mind that those caring for you will know what you want if you are unable to make your own decisions or communicate your wishes and values. Note that your Advance Care Directive only takes effect (can only be used) if you are unable to make your own decisions, whether temporarily or permanently.
A kit for preparing your Advance Care Directive can be downloaded for free at Advance Care Directive Forms and DIY Kit, or a hard copy of the form can be ordered by phone from Service SA at 13 23 24 (during business hours).
Once you have completed the form for your Advance Care Directive, ensure a copy is provided to your GP and your surgeon.

I’m from the country or from interstate. Where can my family and I stay while we’re in Adelaide, and when will we be able to travel home after surgery?

If you are from country SA or interstate, you and your family or escort(s) will need to have accommodation reasonably close to the hospital where you are having surgery. You will need to stay in Adelaide (within an hour or so of a major hospital) for a total of 10-14 days after your surgery, including the time you spend in hospital, before you will be able to be cleared to return home. This is to minimise the chance of a complication occurring after you have left Adelaide, when you may be some distance from help.

Staying with family and friends is fine, or you may choose to stay in paid accommodation such as a hotel or holiday park. You will need to arrange and pay for your own accommodation while you are in Adelaide, as accommodation is not provided by the hospital. You may be able to receive some financial assistance to cover the costs of your travel and accommodation (see below).

Prior to leaving Adelaide, you will need to be reviewed by your surgeon to ensure you are ready to return home. For private hospital patients, this review will occur at our Ashford rooms; for public hospital patients, this appointment will be at Flinders Medical Centre in the outpatients department.

For country South Australian patients, you may be eligible for a subsidy towards your travel and accommodation through the Patient Assistance Transport Scheme (PATS) if you are a permanent resident of South Australia and live more than 100 kilometres from the hospital. Please ask your local doctor, call your local PATS office, or check online at www.countryhealthsa.sa.gov.au/pats for further information.

For Northern Territory patients, you may be eligible for financial assistance from PATS if you have to travel more than 200 kilometres one way to an approved specialist medical service, are eligible for Medicare and are an Australian citizen or permanent resident and have been living in the Northern Territory for six months or more. Please ask your local doctor, call your local PATS office, or check online at: www.nt.gov.au/wellbeing/health-subsidies-support-and-home-visits/patient-assistance-travel-scheme for further information.

When will I be able to drive again after my surgery?

You will need to avoid driving a car or riding a motorcycle for between 2 and 6 weeks, depending on your surgery. This period is both recommended (to allow your bones and muscles to heal) and mandated by law (as your ability to react to an emergency may be affected by weakness, fatigue and/or medications). After heart surgery, there should be no driving for 4-6 weeks, and after lung surgery the recommended period is 2-4 weeks. Please note that, if you choose to drive during this period of restriction, and you have an accident, your insurance is unlikely to cover you. You do not formally need to be cleared to resume driving, but usually you will see your surgeon or referring specialist before this period is finished.

Please also note that, if you hold a commercial driving licence, there is a longer period of restriction on driving your commercial vehicle. You are able to resume driving your own car after the usual 2-6 week period, but you may not be able to drive commercially for up to 12 weeks, and you may need formal clearance to be allowed to recommence commercial driving.

While it is slightly different, you also should not ride a bike outdoors for about 6 weeks after heart surgery or 2-4 weeks after lung surgery. This is because controlling a bike on the road or path may strain your healing wound. Riding an indoor bike (exercise bike or trainer) is fine.

Can my surgery be postponed or cancelled?

Unfortunately, yes. In the event of an emergency or unforeseen circumstances, or if
another patient requires surgery more urgently, your surgery may need to be postponed or cancelled. Should your surgery be postponed, every effort will be made to reschedule your surgery as soon as possible.

Arriving at the hospital

What do I do when arrive at the hospital?

On arrival, you need to report to the Admissions Office or reception desk, where you details will be checked including your full name, your date of birth, your current address, your contact details, and your Medicare and/or private health insurance details.

You will be escorted to the Day of Surgery Admissions unit or to the ward where you will be staying prior to your procedure.

What do I need to do in the days leading up to my surgery?

Please notify us as soon as possible if:

  • You have any signs that may suggest an infection (such as fever or high temperature, cough, cold or flu symptoms, burning or pain on urination, or redness around cuts or scratches on your skin
  • You need to defer surgery for any reason
  • You are unsure about which medications you should stop and which you should continue
  • You have any other questions

After Surgery

While in hospital...

Can my family visit me in the Intensive Care Unit?

Your family are welcome to come and visit you while you are in the Intensive Care Unit. However, they need to be prepared to see you connected up to various pumps and machines, possibly asleep with a breathing tube in your mouth, and probably not looking your best! If they don’t want to see you like that — or if you don’t want them to see you like that — there’s also nothing wrong with waiting until you are out of ICU and on the ward before coming to visit.

We advise that you do not bring children into the ICU without first discussing with the surgical team. The ICU can be a scary place for children, and they may not understand why their loved one is looking unwell or is unconscious, despite recovering routinely and normally from their operation. As most patients stay in ICU for only 12-24 hours, we recommend children visit once you are back up on the ward.

How soon will I be able to get up and move around after my surgery?

In the past, patients remained in bed for several days after their operation to promote rest and healing. However, research has shown there is benefit in getting up out of bed and moving around as soon as possible after your operation. These advantages include improved lung function, reduced risk of blood clots, prevention of pneumonia, decreased length of stay and less loss of muscle tone. Even with the tubes and drains still in your body – often while still in intensive care – you will be encouraged to get out of bed with the help of nursing staff and a physiotherapist. This may be difficult at first, but you will have plenty of help and be safe and supported every step of the way.
Movement after surgery may start the evening of your operation, including bending and straightening your legs almost as soon as you are awake, dangling your legs over the bedside, gently sitting out of bed in a chair, or even a small walk, if you are able. On the first day after your surgery, if possible, you will transfer from the bed to the chair two to three times and gently walk in the room and hallway. On the second day onwards, the physiotherapist and nursing staff will continue to increase your mobility to help you get back to moving as much as possible as soon as you can after surgery.

How long will my surgery take?

The length of your surgery may vary widely depending on how complex it is, and sometimes operations take longer than expected due to delays that may have nothing to do you or your surgery. On average, heart surgery usually takes about 4 hours, and lung surgery varies from less than an hour to more than 3 hours depending on what needs to be done. In addition, there may be up to an hour before surgery taken up getting you ready for your procedure, and you may spend an hour or more after your surgery being made comfortable and settling in, either in Intensive Care or in Recovery. Your family will be able to visit you after that time, but they may be asked to wait longer if your medical care needs to take priority.

Your surgeon will be happy to contact someone you nominate, to advise them when your surgery is completed.

How long will the breathing tube have to stay in?

If you go to Intensive Care after your surgery, you may be kept asleep with a breathing tube in your throat, connected to a ventilator, for a period while the doctors and nurses taking care of you ensure you are stable and recovering appropriately. For most patients, the medication keeping you asleep will be weaned off and you will wake up slowly about 6 hours after your surgery ends. As soon as you are awake enough to breathe on your own, the tube will be removed. There will be a short period where you are awake with the breathing tube in place, but we understand that this may be distressing so this period is kept as short as possible, and the medications you receive mean you may not remember this time.

Sometimes, a patient’s condition means that they need to be kept on the ventilator longer, sometimes for days or even weeks. This is only done if necessary for their safe medical care. If this happens, patients are kept sedated with medications so that they are not aware of the breathing tube in their throat.

Where will I be while I recover from my surgery?

Most patients recovering from heart surgery initially go Intensive Care for about 24 hours, before being transferred to the ward. In the private hospital, most patients having lung surgery also go to Intensive Care for the first night after surgery, whereas in the public hospital these patients go directly to the ward after surgery. In either case, the remainder of your hospital stay will be spent on the ward gradually recovering and getting ready to be discharged home.

What plans should I make for discharge from hospital?

The following is a list of some important tips when planning you discharge from hospital:

  • Most patients are ready to be discharged 5-7 days after heart surgery or 3-5 days after lung surgery.
  • Plan to be off work for between 2 and 12 weeks, depending on the type of work you do (manual workers need longer) and the type of surgery you had. Look into any sickness benefits that may be available to provide you with support during your recovery.
  • You will not be able to drive for 4-6 weeks after heart surgery or 2-4 weeks after lung surgery. You will need to arrange for someone to be available to help you get to and and from your appointments.
  • Although you will be able to care for yourself by the time you are ready to go home, you may like to arrange for help at home for daily activities such as cleaning, grocery shopping, laundry, or gardening for about 6-8 weeks. Nursing and home-care services are not routinely supplied but may be available if needed.
  • If you are not going to be able to manage at home by the time you are ready to leave hospital, rehabilitation or convalescence may be able to be arranged for you.
  • A Discharge Planning Coordinator can be available to you and your family before your surgery and during your hospital stay, specialising in dealing with issues such as decision-making, financial assistance, discharge planning, rehabilitation, home care, or respite care.

What can I do by the time I am discharged?

By the time you are discharged, you should be able to do normal day-to-day activities, such as:

  • Walk short distances
  • Climb a flight of stairs
  • Shower without supervision
  • Prepare light meals

Prior to discharge, you should receive an exercise program, prescriptions for any medications, a plan for rehabilitation or home care (if necessary), and any other instructions needed. We ask you to have someone available to help you at home for about a week after you are discharged; you do not need 24/7 care, but you do need someone available to help you out.

If you live alone, have special needs, or do not have a companion or family member to help after you return home, please notify the hospital staff and arrangements may be able to be made for you to receive additional care.

I felt really down and teary about three days after my operation – I was just starting to feel good before that – what is going on?

It is very common for patients to be emotional after surgery. You’ve been busy preparing for the surgery and now it is all over, you don’t feel good and the result is not there yet. Many patients ask, “What have I done?!” Add in that the natural stress hormones produced by your body drop out at about three to five days after surgery, and you have a perfect formula for feeling depressed and teary (stress hormones are steroids and can elevate mood). Actually this is a normal response to surgical stress.

What follow-up appointments will I need?

After you are discharged, it’s important for you to organise an appointment with your General Practitioner after about a week. This is because your GP is an important part of your ongoing care, and he or she will be able to provide prescriptions for painkillers or other medications you may need. Your GP will be included in any correspondence from your surgeon.

If you are a private patient, an appointment will be arranged for you to see your surgeon about two week after you are discharged, or earlier if you are a country or interstate patient waiting to return home. If you are a public hospital patient, you may be asked to return to the hospital outpatients department for a follow-up appointment.

You will also need an appointment to see your referring specialist physician about 4-6 weeks after your surgery. This appointment should be made for you before you leave hospital, but sometimes the appointment is made after you are discharged and sent out to you. If you do not receive notification of a follow-up appointment, please contact us either by phone or by email and we will be happy to follow this up for you.

Recovering once home...

Since my operation, I seem to feel really good for a little while then go backwards, lacking energy, wanting to cry, or feeling lost – is this normal?

Recovery can be a challenge for the patient and his/her family. There may be days of high energy then days of fatigue, feelings of accomplishment and exuberance and then days of feeling blue, unexpected bouts of sadness and crying, or even getting angry, all of which are very normal as part of the physical and emotional healing process that takes place after surgery. It can take some months for this to stabilise and even up to a year before you truly feel like yourself again.

What do I do about a bra after my surgery?

We recommend that female patients should wear a soft elastic bra (no under wire, usually a size larger around is more comfortable) 24 hours a day for the first six weeks following surgery. This will prevent the weight of the breasts pulling on the healing wound(s), minimising the risk of complications.

I have not been sleeping so well overnight, and have no energy during the day – why can’t I sleep?

It is quite common to have difficulty sleeping at night for some time after major surgery. You may find it difficult to fall asleep, or you may find that you wake up at 2:00 or 3:00 am and cannot fall back to sleep. At the same time, you may find yourself falling asleep a lot during the day, and you may feel very tired.

This will all improve over time, but it is important to re-establish a normal day/night routine. Keeping active during the day, and avoiding daytime naps, helps you to feel tired at night, which will help you sleep better. Taking painkillers just before going to bed can help, as can trying different sleeping positions or even trying to sleep in a recliner rather than a bed.

If you continue to feel very tired all the time, it is important to seek help as this can be a sign of problems such as anaemia.

What am I able to do when I get home?

Once you return home, your recovery from surgery continues. You should carry on with much the same activities as you were doing in hospital, gradually increasing your mobility and independence. Try not to sit around doing nothing as this will not aid your recovery, but at the same time don’t overdo things as you can injure yourself if you attempt an activity you’re not ready for.

As a general rule, you need to avoid any activity that puts a strain on your healing chest wound(s). This means avoiding lifting anything heavier than about 5 kg, for 12 weeks after heart surgery and 4-6 weeks after lung surgery. Remember – if you do something and it hurts, stop doing it!

It is six weeks since my operation yet my chest bones seem to still click at times – is that normal?

After surgery, you may hear or feel popping or clicking sounds in your chest. These are often nothing to be too concerned about, and should gradually settle as you recover from surgery.

However, after heart surgery, if you feel a lot of movement in your sternum (particularly if this is painful) this may be a sign of problems with the healing of the bone. You need to try and absolutely minimise any strain on the healing bone by avoiding the use of your arms for anything strenuous. If the movement and pain persists, please contact us or discuss this with your GP.

I have had my surgery - do I really have to quit smoking?

Ideally, we’d like you to stop smoking before your surgery as this significantly reduces your risk of complications, including heart attack, stroke, pneumonia, and even death.

But if you can’t stop smoking before your surgery, you really should try and quit after your surgery. Obviously you can’t smoke when you’re in hospital, but the difficulty comes when you return home to your familiar surroundings and resume activities that you associate with smoking. If you need our help with quitting, please ask.

There is good evidence that people who continue to smoke after coronary artery bypass grafting have an increased risk of death, probably because of blockages in the new grafts. The risk of other complications is also higher in people who continue to smoke after surgery.

Quitting smoking is one of the most effective ways to improve your health, even in patients already diagnosed with heart or lung disease. There are many factors we can’t control — like age or family history — that increase the risk of heart attack or stroke. However, smoking is something we can actively change and there’s no question that quitting, even after undergoing heart or lung surgery, can go a long way in reducing the risk of future problems.

I’ve been feeling pretty down and depressed after my surgery. Is that normal?

The days and weeks after a major operation like heart or lung surgery can be a difficult time for many patients and their families. The stress of surgery, combined with the effects of anaesthesia and also the heart-lung machine used for heart surgery, can have a major impact on your brain’s chemistry and can leave you feeling quite depressed. This is particularly true if you or your family have a history of depression. Lots of research has been done into this area, and there are many theories as to why this happens, but it is quite common.

Whatever the reason, working through your depression is a critical part of your recovery from major surgery. If you think this may happen to you, put some plans in place before your surgery to keep yourself occupied when you get home, and try to re-establish a normal routine as soon as possible after discharge from hospital. Getting out of the house, visiting friends, or returning to normal activities like shopping can help improve your mood.

However, if you are struggling and feel very down for more than two weeks at a time, it is worth discussing this with your GP. There are some very good support systems available to you, so don’t be afraid to seek them out to assist with your recovery. For example, you can contact Beyond Blue through their website (https://www.beyondblue.org.au/the-facts/depression) or by calling them on 1300 22 46 36.

I have aches and pains in my chest, neck and shoulders, and patches of skin on my chest are numb. What is going on?

It is common to experience all sorts of muscular aches and tightness around the area where you have had major surgery. A lot of the time, this is due to stretching of muscles and ligaments during the surgery, and it gradually gets better with time. Taking simple painkillers like paracetamol or anti-inflammatories may help, and many patients get benefit from massage or physiotherapy.

You may have areas of your chest with numbness, tingling, or altered sensation. This is due to stretching or bruising of nerves, often too small to see, during the surgery. These nerve pains or changes in sensation may take a lot longer to improve, as nerves can take months to heal. Sometimes standard pain medications are ineffective for nerve pain, and you may need to discuss with your surgeon or GP obtaining a prescription for a medication specific for nerve-related (neuropathic) pain.

When can I resume my usual activities?

Please see our pages on resuming normal activities after heart surgery and lung surgery.

Where can I get more information about heart problems?

For rehabilitation advice after surgery, you might like to visit the Heart Foundation website on looking after yourself after a heart attack or surgery, or download the My Heart, My Life book.

Can I use stairs at home?

Yes, but usually only two to three times daily. You will probably be tired and weak during the first few weeks after surgery. However, we recommend that you walk at home three to four times a day for about five minutes at a time. Then, increase activity according to the written instructions provided at discharge.

It has been six months since my operation, yet I am still feeling tired at times – will I ever fully get my energy back?

It takes most people about two to three months to recover physically after the operation. For the first three to six months many people feel very tired, especially at the end of the day. This tiredness and lack of energy gradually improves over the next 12 to 18 months. As a guideline: it takes approximately one month for the vessels to heal, two months for the muscles, six weeks to three months for the bone to mend, three months for blood counts to return to normal and up to 12 to18 months for inflammation to settle down and your full strength to return.

I needed a dental clearance prior to my heart valve operation, but now after my operation I want to have a tooth removed - is it okay to go and get this done?

Try not to have any elective dental procedure for at least three months following your valve surgery. Dental and other surgical procedures can release bacteria into your blood, causing infection and possible damage to your heart and valve. To prevent bacteria from causing infection to your valve, always take an antibiotic before any dental work, surgical procedure, or placement of a tube or catheter inside your body. Also your dentist will probably want to temporarily stop your blood-thinning medication which is not recommended in the first three months.
If you have any further questions, please do not hesitate to send us a message, phone us at Adelaide Cardiothoracic on (+61) 08 8375 5950 or email us at contact@adelaidecardiothoracic.com.au.
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