Is Open Heart Surgery Safe For The Elderly
For many years, performing open heart surgery on elderly patients was considered too risky as an increase in age is associated with increased risks of negative outcomes following surgery. However, as surgical techniques have advanced and patient care especially for octogenarians has improved, more and more surgeons are feeling comfortable recommending open-heart surgery for their elderly patients. In fact, in 2008, a study of more than 1000 patients aged 80+ indicated that operative mortality rates had been reduced from 15% to 2.2%, with more than 97% of participants reporting an improved quality of life following their procedures.
Of course, this doesnt mean open heart surgery is completely safe for the elderly rather, it simply suggests old age should not be a disqualifying factor in and of itself for these procedures. Doctors should consider the fact that individuals aged 80+ do tend to suffer from a higher number of risk factors or comorbidities that may increase the risks associated with undergoing open-heart surgery. Some of these risk factors or predictors of a poor outcome in the elderly include:
- Preoperative: diabetes mellitus recent myocardial infarction, renal dysfunction, obesity, COPD , smoking, and being of female gender.
- Intraoperative: experiencing a long cardiopulmonary bypass time or undergoing emergency operation or reoperation.
- Postoperative: atrial fibrillation or post-operative bleeding.
Six Weeks To Three Months
After six weeks, youll be largely recovered and youll then be able to resume heavier housework and gardening, business or recreational travel, aerobic exercises without weights, driving, and dog walking.
The expectation, more or less, is that you can start moving towards pre-operation levels of activity. That said, dont push it and seek out your healthcare providers clearance if you want to try anything more strenuous or new.
A Chest Pillow Is A Must
Having a pillow to stabilize your chest is a must. Most hospitals will send you home with one, but if they dont, make sure to get one. Chest pillows can help you when you sleep, sneeze, and cough they have has many uses. I had a pillow with me for almost a year after my last surgery and I still usee one during long trips in the car.
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What Should I Expect During Recovery At Home After Heart Surgery
The first six to eight weeks after heart surgery are usually the most challenging. You may recover quite quickly if you were in good health before your operation. However, your recovery may be slower if you were very ill before surgery or if you experienced any complications after surgery.
Remember that you should see slow steady improvement as you recover. Call your family doctor if you have or develop any condition that seems to get steadily worse over three days.
Managing follow-up appointments
What kind of follow-up appointments will I need after my heart surgery?
Once you are home from the hospital after your heart surgery, please arrange the following appointments:
- Within the first week you are at home, call to make an appointment to see your family doctor to have your sutures or clips removed. Remember to bring the removal kit you were provided with before you left the hospital.
- Your heart surgeon may see you two to three months after your surgery for a follow-up appointment. Please refer to your personal discharge documents for details. Call 604-522-6800 to arrange this appointment.
- You should also expect a call from a cardiac rehabilitation program. Referrals are made automatically when you are discharged and you do not need to initiate this call yourself.
Make an appointment with your family doctor if your incision continues to drain and/or you note any signs of infection.
When will my incision heal into a scar and how do I care for it?
Lifting During Household Chores
Your sternum may remain sore for up to two months, maybe longer depending on your individual medical history.
You can perform most domestic duties such as washing dishes, preparing meals, washing clothes, light cleaning, and shopping.
Try not to lift much more than 2 to 4.5 kg during the initial recovery period until you receive clearance from your surgeon or cardiologist.
Pay attention to pushing and pulling activities that jar your sternum and cause discomfort.
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Resuming Normal Activities After Open Heart Surgery
Its important to remember that not everyone heals at the same rate. People who have diabetes or are taking steroids may take longer to heal after surgery. Age can play a role, too, as recovery may take longer in adults who are older. Complete recovery takes about three to six months.
At any phase in your recovery, using common sense is the best way to keep yourself from overdoing it, Dr. Tong says.
If an activity causes pressure or pain, stop. If your sternum doesnt heal properly after surgery, it can cause you a lot of pain and complicate the healing process.
If you arent sure an activity is safe, check with your surgeon first. And contact your doctor right away if you experience:
- Redness on your chest larger than a quarter or drainage that resembles pus. This might signal an infection.
- A clicking noise in your chest when you cough or breathe deeply. This could mean the wire holding your sternum together has broken.
- Abnormal pain.
Overall, give yourself time to heal, while gradually doing a little more each week. Continue to work with your doctor until youre up to speed on your normal activities.
What Are The Most Common Complications During Cabg Recovery
When you are ready to go home, you will be given a list of medications and instructions to help you recover from your operation. You will likely have some new prescriptions, and you may be told not to take some of your old medications. This may seem a little overwhelming at first, but your nurse will sit down with you and go over the instructions in detail. If you have any questions, your nurse will be able to help make things clear before you leave.
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So What Happens Once I’m Discharged Home
At this point now you’ll probably be happy to be home and out of hospital… in your own comfortable surroundings.
But with this…
Come the alarming feelings of being overwhelmed and stuck.
At the hospital you felt safe…it wasn’t as terrifying as it is now that your home, alone without the nurse nearby.
The first thing you need to understand…is that your chest bone has been cut apart. This was necessary for the surgeon to be able to work on your heart.
Don’t make the mistake of slowing down healing process by using your arms too much after surgery.
It’s going to take up-to 8-weeks for your sternum to heal after bypass surgery.
So you need to be careful about using your arms once you are at home.
Pushing and pulling must be avoided to limit separation of your sternum.
This means no lifting any heavy items nor carrying any children.
A good measuring stick is….anything heavier than a half pot of water is a NO-GO!
Open heart surgery, for this reason has a slower recovery time.
Your surgeon wants to limit any separation of the wound site, and this is why most cardiac rehab programs don’t start until 6-8 weeks after surgery.
This is so cringe-worthy to me.
It makes me want to scream when I first meet a patient whose had bypass surgery and they were told to wait 8-weeks before doing anything.
Just because you have restrictions with lifting or resistance exercise, because of the chest incision…shouldn’t mean that you can’t work on your aerobic fitness.
Of course you can!
Who Will Help Perform The Bypass Surgery
Throughout the surgery, several types of specialists ensure the procedure is performed properly. A perfusion technologist works with the cardiopulmonary bypass machine.
A cardiovascular surgeon performs the procedure and an anesthesiologist ensures anesthesia is delivered to your body properly to keep you unconscious during the procedure.
Imaging specialists may also be present to take X-rays or help ensure that the team can view the site of the surgery and the tissues around it.
When you wake up from heart bypass surgery, youll have a tube in your mouth. You may also feel pain or have side effects from the procedure, including:
- pain at the incision site
- pain with deep breaths
- pain with coughing
Youll likely be in the ICU for one to two days so your vital signs can be monitored. Once youre stable, youll be moved to another room. Be prepared to stay in the hospital for several days.
Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:
- caring for your incision wounds
- getting plenty of rest
- refraining from heavy lifting
Even without complications, recovery from heart bypass surgery can take 6 to 12 weeks. Thats the least amount of time it takes for your breastbone to heal.
During this time, you should avoid heavy exertion. Follow your doctors orders regarding physical activity. Also, you shouldnt drive until you get approval from your doctor.
- fever over 100.4°F
- increasing pain in your chest
- rapid heart rate
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Your Personality And Mood May Change After Open
After open-heart surgery, many people experience personality and mood changes. The most commonly experienced emotions are depression, fatigue and anxiety. These can be caused by being on bypass, anesthesia, or medication such as oxycontin. You may experience mood swings like crying or getting angry or easily frustrated.
I mostly experienced this after my second open heart surgery when I was a teenager and my third open-heart surgery. After both of them, I experienced depression, anxiety and PTSD. Before my second open heart surgery, I was more outgoing but afterward, my personality changed and I was quieter and self-reflective. I struggled with suicidal thoughts and mood swings. After my most recent surgery, I finally got the therapy I needed after years of not seeking help. If you are struggling, please find help, be open with your doctor and make sure you have someone to talk to.
What Should You Avoid Doing After Having Cabg Surgery
Your body needs quite a bit of time to heal after a major surgery like CABG. Its important to follow your care teams instructions and ask them when you have questions. They will likely advise you to avoid certain activities while you recover, some of which may include the following:
It takes time for the sternum to heal. So for at least a couple of weeks after surgery, most people should avoid lifting, pushing, or pulling more than 10 pounds.
You should also limit use of your arms to simple everyday tasks like getting dressed and playing cards. In other words, dont lift your arms above your head or behind your back.
Dont drive for the first 2 to 3 weeks. This helps avoid injuring your chest, but its also because you may still be on pain meds and not feeling 100% yet.
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What Is Open Heart Surgery
In the case of coronary artery disease, surgery may be indicated when blockages are too widespread for angioplasty and stenting or if a blood vessel is too difficult or risky to access with a coronary catheter.
Mitral and/or aortic valve repair or replacement are also common open heart surgery procedures and may stem from a case of childhood rheumatic fever, or perhaps valve damage associated with viral or bacterial endocarditis.
No matter what the reason for your surgery, the recovery time and subsequent exercise prescription are quite similar.
Preparing For The Surgery
Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.
It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.
Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.
It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.
The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the persons chest area before they can have the anesthetic.
The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.
After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.
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Managing Pain After Open Heart Surgery
Managing your pain is an important part of your recovery after heart surgery. In addition to keeping you comfortable, pain control can help speed your recovery and reduce your risk of developing certain complications after surgery, like pneumonia and blood clots. Your pain level should be managed to the point that youre able to get up, walk around, cough and take deep breaths after surgery.
After heart surgery, you need to be able to move with some degree of comfort to aid the healing process, Dr. Tong says. Keeping your pain level manageable will help make sure your recovery stays on track.
You may leave the hospital with a prescription for pain medication and detailed instructions on how to use those medications to manage your pain.
People are often apprehensive about taking narcotic pain medications because of the risk of addiction, Dr. Tong notes. That is a healthy and very reasonable fear and an important conversation to have with your doctor. There are safeguards in place to stem opioid abuse and protect you from abusing medications. When it comes to prescription pain medication, for most people, its a matter of listening to your body. If you need it, take it. If you dont, dont.
If you have concerns about bringing narcotics into your home, or if you have a history of substance use disorder, be honest with your doctor. Theyll be able to discuss your options with you and determine a pain control plan with you.
Handling Your Baby After Surgery
To ensure your that babys wound heals evenly, it is important not to pick them up under their arms for a period of 6 weeks. The nursing staff will teach you how to pick you baby up using the scoop technique. When you go home it is important that you teach anyone who might pick up you baby how to do so correctly.
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Types Of Strength Training
Resistance bands or tubing
Resistance bands or tubing can be a great way to perform resistance exercise because its simple, easy to use, and does not require expensive equipment.
Resistance machines found in gyms work your muscles but keep your body within a safe guided range of motion.
Free weights include dumbbells and barbells and require you to balance and stabilize the weights through the range of motion. If youre a new exerciser, it may be advisable to hire a trainer to help you with correct technique.
From Hospital Discharge To Six Weeks
As you begin getting back into your routine, remember to start with small tasks and take plenty of breaks. Dont overdo it.
After you leave the hospital, unless your surgeon says otherwise, you may return to activities such as:
- Light cleaning.
- Climbing stairs.
Some things are still off limits, though.Dont lift, pull or push anything that weighs more than 10 pounds. Its too soon to drive, too, but its OK to ride in a car.
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You May Experience Sleep Issues
Many people complain of having trouble sleeping for some time after heart surgery. You may experience insomnia because of:
Effects of anesthesia
Changes in your daily routine
Stress from personal concerns
Normal sleeping patterns typically return in two to three weeks. Until then, try these tips:
Take enough rest breaks in between your normal daily activities but avoid a daytime nap longer than 20 minutes.
If you have pain, take your pain medication about 30 minutes before bedtime.
Arrange the pillows so you can maintain a comfortable position and decrease muscle strain.
If you feel anxious or nervous, talk to your spouse, partner or a trusted friend. Get your troubles off your mind.
Avoid caffeine in the evenings.
Listen to relaxing music or a guided imagery audio program.
Ask your partner to give you a back rub.
Take a relaxing shower.
Follow a bedtime routine to let your body know its time to relax and get to sleep.
Its OK to sleep on your back, side or stomach. You will not hurt your incisions.
Resuming Physical Activity After Surgery
If your energy level is running low, remember that its normal to feel tired after surgery. It may be frustrating at times not being able to do everything you did before your surgery, but just relax and know that this is only temporary.
Before you get back to any vigorous forms of activity, its important to get comfortable doing what are known as ADLs, or activities of daily living.
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