Last updated: 11/24/2009

Recovery in the hospital

The patient recovers in a surgical intensive care unit for one to two days after the surgery. The patient will be connected to chest and breathing tubes, a mechanical ventilator, a heart monitor, and other monitoring...

equipment. A urinary catheter will be in place to drain urine. The breathing tube and ventilator are usually removed about six hours after surgery, but the other tubes usually remain in place as long as the patient is in the intensive care unit.

Drugs are prescribed to control pain and to prevent unwanted blood clotting. Daily doses of aspirin are started within six to 24 hours after the procedure.

The patient is closely monitored during the recovery period. Vital signs and other parameters such as heart sounds, oxygen, and carbon dioxide levels in arterial blood are checked frequently. The chest tube is checked to ensure that it is draining properly. The patient may be fed intravenously for the first day or two.

Chest physiotherapy is started after the ventilator and breathing tubes are removed. The therapy includes coughing, turning frequently, and taking deep breaths. Sometimes oxygen is delivered via a mask to help loosen and clear secretions from the lungs. Other exercises will be encouraged to improve the patient's circulation and prevent complications due to prolonged bed rest.

If there are no complications, the patient begins to resume a normal routine on the second day, including eating regular food, sitting up, and walking around a bit. Before being discharged from the hospital, the patient usually spends a few days under observation in a nonsurgical unit. During this time, counseling is usually provided on eating right and starting a light exercise program to keep the heart healthy.

The average hospital stay after coronary artery bypass graft surgery is five to seven days.

Recovery at home

INCISION AND SKIN CARE. The incision should be kept clean and dry. When the skin is healed, the incision should be washed with soapy water. The scar should not be bumped, scratched, or otherwise disturbed. Ointments, lotions, and dressings should not be applied to the incision unless specific instructions have been given.

DISCOMFORT. While the incision scar heals, which takes one to two months, it may be sore. Itching, tightness, or numbness along the incision are common. Muscle or incision discomfort may occur in the chest during activity.

Swelling or aching may occur in the legs if the saphenous vein was used for the graft. Special support stockings may be needed to decrease leg swelling after surgery. While sitting, the patient should not cross the legs and the feet should be elevated. Walking daily, even if the legs are swollen, will help improve circulation and reduce swelling.

LIFESTYLE CHANGES. The patient needs to make several lifestyle changes after surgery, including:

• Quitting smoking. Smoking causes damage to the bypass grafts and other blood vessels, increases the patient's blood pressure and heart rate, and decreases the amount of oxygen available in the blood.
• Managing weight. Maintaining a healthy weight, by watching portion sizes and exercising, is important. Being overweight increases the work of the heart.
• Participating in an exercise program. The exercise program is usually tailored for the patient, who will be encouraged to participate in a cardiac rehabilitation program supervised by exercise professionals.
• Making dietary changes. Patients should eat a lot of fruits, vegetables, grains, and non-fat or low-fat dairy products, and reduce fats to less than 30% of all calories.
• Taking medications as prescribed. Aspirin and other heart medications may be prescribed, and the patient may need to take these medications for life.
• Following up with health care providers. The patient must schedule follow-up visits to determine how effective the surgery was, to confirm that progressive exercise is safe, and to monitor his or her recovery and control risk factors.