Having Thoracic Surgery

The Division of Thoracic Surgery of the Brigham and Women's Hospital (BWH) is committed to providing timely, comprehensive and caring services throughout your surgery--beginning with your first visit and continuing throughout your hospital stay, discharge, and follow-up visits in the clinic.

We strongly believe that patients--and their family and friends--are an integral part of the health care team. We welcome questions, participation and support.

Preparing for Your Thoracic Surgery Topics

Comprehensive Care Team

In addition to surgeons, physician assistants and nurses, you may receive care from any or all of the following supportive services: pulmonary medicine, anesthesia, chest physiotherapy, cardiology, nutrition support, social work services, continuing care and our chaplain service.

Scheduling Your Surgery

If, after evaluation by and consultation with your thoracic surgeon, it is determined that surgery is necessary, you will meet with one of our surgical coordinators. The coordinator will schedule your pre-operative testing at the Weiner Center for Preoperative Evaluation preoperative testing (Pre-Admission Testing Center PATC) as well as a time and date for your thoracic surgery.

Call to Confirm the Day Before Surgery

Please call the surgical coordinators at (617) 525-3210 between the hours of 3 and 4pm the day before your scheduled surgery to confirm.

You will also be given information about what you must do to prepare for your surgery as well as the time you should arrive at the hospital on the day of your surgery. In addition, you will be provided with a packet of information detailing what you will need to know about your hospital stay. The surgical coordinators are also available by phone to answer any questions you may have after you leave the clinic.

Weiner Center for Preoperative Evaluation

Shortly after your surgery is scheduled, a surgical coordinator in the thoracic surgery office will give you the date and time of your pre-admission testing appointment.

On the day of your appointment, you should report directly to the Weiner Center for preoperative testing. The Weiner Center is located in the Pike hallway just across from the 45 Francis Street lobby.

The following routine pre-admission procedures will be performed:

  • Diagnostic tests will be taken, which may include a chest X-ray, electrocardiogram, urinalysis and blood tests.
  • Your physical and medical history will be reviewed. At this time, a member of the staff will hear any concerns and answer any questions you may have about your surgery or your stay in the hospital.
  • A nurse in admitting will explain the pre-operative and post-operative routine to you and your family.
  • An anesthesiologist assigned to your case will discuss his or her role in your care. Once you have received an explanation of the anesthesia and its associated risks, you will be asked to sign a separate consent form for anesthesia.
  • The chest physiotherapist will evaluate you if this was not previously done in the thoracic surgery office.

The pre-admission procedure usually takes approximately three hours, but it may take longer. We ask for your patience during this process, as work performed in the hospital is not always predictable and delays do occur.

Preoperative Information

Help Yourself Recover Quickly

There are two things you can do to help yourself through surgery:

  • STOP SMOKING if you are a smoker. Smoking robs your body of oxygen and interferes with your ability to recover quickly.
  • Exercise to stay fit. Maintaining or increasing your level of exercise before surgery is also important. Walking is an excellent form of exercise, and a daily walk is recommended. The more "fit" you are, the more likely you are to make a faster recovery.

Most patients are admitted the day of their surgery, although for some procedures patients are admitted the evening before surgery.

Eating Before Surgery: On the day before your surgery, you will be allowed to eat and drink until midnight. After midnight you may not have anything by mouth.

Medications: If you have been on medications at home, your doctor will determine which ones you will continue to take prior to surgery. If you need these medications after midnight, you may take them with a small amount of water.

Valuables: Please leave all valuables such as money, credit cards, and jewelry at home or sent home with family members. If this is not possible, valuables can be stored in the Cashier's Office (in the main lobby) until you are ready to retrieve them. All jewelry including wedding bands must be removed before surgery. If you are unable to remove your band, it may be necessary to remove it with a ring cutter.

Call the Day Before Surgery: Please call a surgery surgical coordinators at (617) 525-3210 between the hours of 3-4pm the day before your scheduled surgery to confirm surgery and for instructions on when and where to report for surgery.

Day of Surgery

The surgical coordinators will provide you with all your instructions for the day of surgery. If you have questions please call their office at 617-525-3210.

The Post-operative Period

After your surgery, you will spend a short time in the recovery room before being transferred to the thoracic intermediate care unit (TICU) on the 11th floor of the Tower at 75 Francis Street. Some patients may require additional monitoring that can only be provided in the surgical intensive care unit (SICU). This decision is made at the discretion of your surgeon, and usually you will know if you are going to be cared for in the SICU before you go in for your surgery. Sometimes, however, space considerations or other circumstances beyond our control warrant a different bed assignment.

You will stay in the recovery room for one-two hours until you are ready to be transferred to the TICU or SICU. In the recovery room you will have a chest X-ray and the nurse will take your vital signs every 15 minutes. You can expect the following lines and tubes to be in place:

  • Oxygen mask: to provide humidification and oxygen
  • Arterial line: to draw blood and measure blood pressure
  • Chest tube: to drain fluid and air from your lung to keep it expanded
  • IV line: to give medication and fluid
  • Pulse oximeter: to measure oxygen levels

Most thoracic surgery patients are admitted to one of the thoracic intermediate care units on 11A, 11B and 11D or directly to the thoracic ICU on 11C. The thoracic intermediate care unit (TICU) consists of 45 monitored beds, 12 of which have air-flow control making them suitable for lung transplant patients. These beds are fully monitored including ECG, oximetry, as well as continuous arterial line monitoring. They are distributed in three individual units. Patients are attended by a flexible nursing-to-patient ratio based on protocols and needs of the patient.

Your Role in Your Recovery

You will begin deep breathing and coughing exercises on the evening of your surgery. These exercises will help clear the secretions from your lungs and prevent pneumonia. You will be getting out of bed and walking on the morning after surgery. There are several exceptions to this rule which will be discussed with you if you fall into an "exception" category. We use a specially adapted walker that provides extra support and oxygen. Walking will help your breathing and maintain your strength following surgery. The nurse or therapist will accompany you when you walk.

For the first few days after your surgery you may need extra oxygen, but as your lung heals you will find you need it less and less.

Depending on your surgery, you may begin shoulder exercises as soon as you can tolerate them. These exercises are important, because without them your shoulder may stiffen up.

Try to catch naps whenever possible. Rest is important to the healing process. Nourishment is also vital to healing. Although you may not be hungry, try to eat something at each meal.

Because various aspects of your nursing care must be administered 24 hours a day, you may notice while you are in the TICU that your normal sleep routine is disrupted. Although you may feel tired, you may be awoken at night for chest physical therapy, and vital signs are taken periodically throughout the night. As you continue to improve after surgery, your need for aggressive care at night will decrease and your opportunity to sleep for longer periods of time will increase.

We find it is best for patients to limit the number of visitors. You will be feeling tired after your surgery and will need to get rest. It is a good idea to designate one individual as your contact person, who will receive telephone calls from and give updates to family and friends about your condition. By doing so, you will also reduce the number of calls to the nurses station, which allows the nursing staff to devote more of their time to patient care.

The length of stay varies depending on your surgery. A follow-up visit will be scheduled 10-14 days after discharge.

When you are ready to leave the hospital, you will be given a follow-up appointment with the surgeon, and will receive written discharge instructions and prescriptions from your nurse or physician assistant.

After Your Discharge

After discharge from the hospital you may have questions or issues you wish to discuss with your surgeon or his or her staff. Telephone numbers for contacting your surgeon will be listed on your discharge instruction sheet. Please do not hesitate to call.

Keep in mind that because your surgeon has a busy operating schedule, he or she may not be available to speak with you during the day. However, a member of the Thoracic Surgery division will get back to you as soon as possible.

It is wise to take your temperature daily and notify the doctor if you develop a fever. You should also notify the doctor of any change in the amount or color of the phlegm you produce while coughing. You should also call if you notice a change in or difficulty with breathing.

Upon your return home, give your primary doctor a call to let him or her know that you are out of the hospital. You may inform your primary care doctor that your surgical information will be forwarded after your first follow-up visit.

Wound Care

You should wash the incision with soap and water during your daily bath or shower. Swelling around the incision is very common and it will go down with time. Please notify the doctor if there is any drainage from the incision. Some people complain of numbness around the incision as well as pain.

Activity

You should continue with deep breathing and coughing exercises when you return home. You should also continue to exercise your shoulder. You may be stiff and sore and this can last for several weeks to a month following surgery.

There are several limitations to your activity following discharge. You should not drive a car while you are on pain medication. Refrain from lifting heavy objects, including children, until after your post-operative visit. Avoid any heavy pushing or pulling as well.

You should take a 15-minute walk daily. Over time, try to build up to a one-hour walk daily. The purpose of walking is to build your endurance and improve your lung function.

It is normal to feel somewhat tired for the first several weeks after discharge. Do not overexert yourself. Your body is recovering from surgery and it will take time to return to your normal routine.

Pain Medication

You will be given prescriptions for pain and any other medications that you need. If you feel that you need more pain medication after discharge, please call your doctor's office. Remember that pain medication works best if taken before the pain becomes too severe.

Follow-up Visit

You will have a follow-up visit 10-14 days after discharge. Your physician assistant or care coordinator on the floor will make the appointment for you. You should go to the Outpatient Radiology Department (45 Francis Street entrance) for a chest X-ray immediately before your appointment.

Resources

Go to our online health library to learn more about thoracic diseases and tests.

Visit the Kessler Health Education Library in the Bretholtz Center where patients and families can access computers and knowledgeable staff.

Access a complete directory of patient and family services.

Visit the Dana-Farber/Brigham and Women’s Thoracic Lung Cancer Center for more information about thoracic cancer.